Corneal Transplant

Corneal transplantation may be required for persons with corneal injury or disease, severe corneal scarring, or cloudiness of the cornea that limits vision. Occasionally a corneal transplant may be required due to complications of LASIK surgery, such as ectasia, infection, flap melt, or severe irregular astigmatism.

In corneal transplant surgery, an eye surgeon removes a section of the recipient-patient's cornea and sutures the donor tissue (graft) onto the eye. Healing and visual recovery may take up to a year or longer, during which time topical steriod drops are prescribed to prevent rejection.

Images courtesy of Dr. Edward Boshnick.

As we have reported in other sections of this website, LASIK flaps and RK incisions never heal and remain open for the rest of a patient's life. This situation exposes LASIK and RK patients to a life-long increased risk for corneal infection. LASIK and RK patients who develop untreatable infection may be required to undergo corneal transplant, sometimes even many years after the surgery.

The two images below are photos of a transplanted cornea two weeks after surgery in an eye that previously had RK surgery. Green dye has been instilled into the eye, which highlights damaged tissue under blue light.

corneal transplant 2 weeks after surgery

corneal transplant 2 weeks after surgery

The photo below shows the cornea of a patient who had RK (radial keratotomy) surgery in 1988. Eighteen years later she developed an infection and inflammation. In all likelihood, an opportunistic organism penetrated the cornea through an RK incision. The infection was unresponsive to antibiotic eye drops, so the patient was hospitalized and treated with a 7-day course of intravenous antibiotics. Unfortunately, the damage to the cornea led to need for a corneal transplant. Due to large open RK incisions, scar tissue from infection, and the extremely irregular corneal surface, the surgeon was forced to place the donor cornea off-center. The vertically placed sutures located at 9:00 and 7:00 were placed to prevent the open RK incisions from rupturing.

The 2nd image is the same eye two years earlier, post corneal transplant, with stitches holding the decentered donor tissue in place.

post RK, infection, transplant

post RK, infection, transplant

The photo below is a rejected corneal transplant. The patient had four previous corneal transplants.

rejected corneal transplant

Below, same eye as above after instillation of green dye.

The image below is the eye of a patient who had a corneal transplant following botched RK. Note the RK incisions in the superior visual field. Stitches still remain from the 9 o'clock position to the 12 o'clock position three years after the transplant surgery. The donor cornea had to be placed off-center due to the long, deep RK incisions.

The donor cornea in the photo below is cloudy and breaking down -- in other words, being rejected -- several years after surgery. This patient did not have refractive surgery.

Note the sutures in the photograph below of a corneal transplant one week after surgery. As the tissue heals over the weeks and months following surgery, some of the sutures may 'pull' and other sutures may have a 'relaxing effect' on the corneal contour. For this reason (among others), the cornea will typically heal with a very irregular surface. The majority of corneal transplant patients will require a specialty contact lens to improve vision.

photo of corneal transplant

The next four images are sequential photos of the same eye. Unfortunately, this patient's donor cornea was rejected. Another transplant was done about a month later. Shortly after the second transplant the patient developed an infection within the eye (endophthalmitis). Due to the resultant debris created within the eye from the infection a vitrectomy was performed (vitreous was removed and replaced with an inert solution). However, the infection and it's aftermath caused a retinal detachment. The patient's intraocular pressure also dropped dramatically causing the iris tissue to be "sucked" into the globe obliterating the pupil. The patient is now blind in this eye with no light perception and no possibility of regaining useful vision. This condition is called Phthisis Bulbi and often results in enucleation of the eye. Click photos to enlarge.

We published this patient's case to make the point that a corneal transplant is not a risk free procedure. Although what you see here is extremely rare, there is always the unforeseeable that may occur when any type of invasive eye surgery is undertaken.

July 2009 update: This patient has developed severe eye infection and inflammation and will probably have to have the eye removed due to recurrent infections and constant pain. These images are being published to warn patients that unexpected complications can take place with disastrous consequences. When it comes to the eye, nothing should be taken for granted.

The photo below is another rejected corneal transplant.

rejected corneal transplant

A bad LASIK outcome may result in need for corneal transplant; however, vision may still be poor after the transplant surgery requiring use of hard (rigid) contact lenses. The photo below shows a scleral contact lens over a corneal transplant. You can clearly see the ring around the edge of the donor tissue where the scar formed, bonding the transplant to the cornea.

scleral lens over corneal transplant

The image below is a cross sectional scan of a corneal transplant. The patient is wearing a rigid scleral contact lens. The patient had a corneal transplant 10 years ago, which left the patient with poor vision and unable to tolerate any type of corrective lens. With the scleral lens the patient has 20/30 vision and good comfort. Yellow arrows point to the juncture where donor tissue connects to the patient’s cornea. Click image for larger view.

cornea of a patient with corneal transplant wearing scleral lens

The two images below are corneal topographies of eyes that have undergone corneal transplant. The large range of colors represent significant changes in corneal steepness and refractive power across the central diameter of the cornea. Red represents the steepest areas of the cornea. Deep blue represents the flattest areas. These topographies demonstrate corneas with very irregular surfaces full of hills and valleys and not smooth or spherical. Corneal surface irregularity produces a distorted image on the retina. Compare these topographies of corneal transplants to the topography of a normal eye at bottom.

topography of corneal transplant

topography of corneal transplant

The image below demonstrates a normal unoperated eye with a desirable corneal topography. This patient has normal vision.

topography of normal unoperated eye

Disclaimer: This information is NOT intended to be used as medical advice. The information contained on this web site is presented for the purpose of warning people about LASIK complications prior to surgery. Persons experiencing vision problems or other eye problems should seek the advice of a physician.