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UNDERSTANDING THE ANATOMY OF YOUR EYES
It is very helpful to have a little information about the different parts of your eye when trying to understand what really happens during your surgery.
The cornea is the clear tissue in front of the pupil and Iris. You actually see through the cornea, just as you would look through a window. Behind the pupil is the lens, which along with the Cornea, focuses the light entering the eye. The retina in the back of the eye is composed of specialized nerve cells that transmit the light impulses coming through the front of the eye to the optic nerve and then to the brain. In a healthy, normal eye, light passes through the cornea and lens, and is focused on the retina. Sharp vision requires all structures of the eye to be in good working order. Like a foggy window, loss of transparency of the cornea will contribute to reducing vision. Clouding of the cornea can be related to many factors, such as injury, infection, congenital disorders, and aging.
In a corneal transplant procedure, the central portion of your cloudy cornea is replaced with clear corneal tissue from a donor.
CORNEAL TRANSPLANT SURGERY
A corneal transplant involves removing the cloudy central portion of your cornea and replacing it with an exact duplicate ''button'' of healthy corneal tissue from a donor.
When the lens of the eye becomes cloudy, it is called a cataract. In some cases, removal of the cataract can be combined with a corneal transplant procedure. If a cataract is removed at the time Of surgery, a lens implant (which replaces your own natural lens) may be inserted. In patient who have had previous cataract Surgery and lens Implant, the lens already implanted in the eye may have to be removed or exchanged during surgery for another type of lens.
Occasionally the vitreous jelly can protrude forward toward the cornea: This is most common in patients who have had previous surgery or Injury. If the vitreous jelly has moved close to the cornea, It must be removed at the time of transplant surgery. This procedure is called a vitrectomy. The healthy donor cornea is then fixed into position by sutures that are only one/third tee thickness of a human hair.
Most commonly we use a modified form of local anesthesia for corneal transplant surgery. You are given medication intravenously which induces a twilight sleep in which you will be awake be but very calm and relaxed. Complicated or prolonged cases are evaluated individually and may require general anesthesia. If you are extremely nervous or are unable to lie on your back awake for any length of time, we may recommend general anesthesia.
DONOR CORNEAS
In 1944 the world's first eye bank was organized In New York. There are now over one hundred eye banks across the country. When a hospital or emergency room has a terminally ill patient who has designated that his/her eyes will be donated, the nearest regional eye bank coordinates the collection of the donor eyes. The donated cornea is then placed in a storage solution which can keep it healthy for several days. During this time the eye bank performs tests on the tissue to be certain that the donor did not have a disease that could be transmitted with the cornea. The eye bank then contacts surgeons who have patient most in need of a corneal transplant so plans for the surgery can be finalized. Most eye banks in the United States are tracked be a computer system that lists the availability of donor corneas across the country. We often use corneas from eye banks in other parts of the country.
Unfortunately there are many more patients who need corneal transplant than there are donors. Therefore, it could take several weeks or longer to obtain a cornea for your surgery.
The age, race, sex, or eye color of the donor do not affect the outcome of transplantation surgery as long as the cornea is otherwise healthy. (One exception would be a very young patient at who might need tissue from a young donor to assure longevity of the corneal tissue.) Likewise, it does not matter if the donor was nearsighted or farsighted.
Unlike other types of transplant, such as heart or kidney, there IS usually no need to match the blood of the corneal donor to the recipient. However, in patients who have already had several failed transplants or after certain types of corneal Infection, it may be necessary to match the donor to the recipient.
POST-OPERATIVE CARE
Hospital stay: Normally you will be discharged home the same day of surgery, although in certain circumstances you may stay overnight. This will be discussed with you.
PROTECTION OF THE EYE
One of the most important things you must do is protect the operated eye at all times! For the first few weeks after surgery, even a mild blow to the eye could cause the transplant to loosen. This might require further surgery, or even a new transplant.
During the day you may use an old pair of prescription glasses, or an Inexpensive pair of non-prescription g1asses. Alternately, you may use the metal or plastic eye shield which you received in the hospital. The shield should be taped across the eye from the center of the brow to the cheek. Protection of the eye does not have to be airtight - wind or small amounta of dust are generally not harmful to the eye. Of more concern are the seemingly insignificant traumas such as from a child's finger, a pet's paw, or the edge of a door or piece of furniture.
The eye shield should be used when you go to bed at night.
The eye must be protected at all times for at least four weeks.
After that time eye protection is no longer needed for normal activities or sleep.
The gauze pad which was over the eye in the hospital is mainly to help keep the eye closed and to absorb excess tears for the first few days after surgery. If you are not feeling an: discomfort in the eye and are having minimal tearings you do not need to use the pads. The gauze pads alone are not adequate protection for the eye! To adequately protect the eye you must use either glasses or the eye shield.
Remember..... after a corneal transplant the eye never heals with the same strength of a normal eye, even years after surgery. Therefore, if you participate in any activity where there is a possibility of direct blow to the eye (contact sports, hockey, lacrosse, tennis, racquet ball, etc.) protective eyewear must be worn.
RETURN TO ACTIVITY
After surgery you may return to light activity as soon as you feel physically able. Walking, eating with friends or family, watching TV, reading, short trips away from home and light housework are all permitted. You may ride in a car or fly in an airplane immediately after surgery. You should not drive a car or pilot an airplane immediately after surgery since your depth perception and field of vision will not be normal. Sexual activity of a conservative nature may be resumed after a week (with eye protection in place).
The first month after surgery, you must avoid:
Lifting objects that weigh more than 5-8 pounds (children, pets heavy packages). You may lift light objects such as shoes, small packages, etc.
Bending from the waist especially when trying to lift something from the floor. You should always bend your knees or kneel to pick things up.
Bathing: Showers may be taken immediately, being careful not to allow the shower stream to strike the eye directly. Going to the beauty salon is fine as long as you use the eye shleld for the first month after surgery to protect against splashes or an inadvertent finger in the eye. Shaving may be done in the normal fashion the day after Surgery.
Athletics: Strenuous athletic activities can usually be resumed 3-4 weeks after surgery. Do not, however, return to any athletic activity without first consulting your doctor.
Return to work: Desk work can usually be resumed within the first week after surgery. Physical labor in most cases can be resumed in 3-4 weeks. However, do not return to any physical labor without first consulting your doctors
In general let common sense be your guide... If you think you probably should not do something, don't do it.
RECOVERY PERIOD
Immediately after surgery the eye may be red and irritated, and the vision poor - sometimes worse than before surgery. This is usually normal. The irritation in the eye will generally improve over the first week. The redness will usually clear in 2-5 weeks.
You will be given eye drops and sometimes pills to help endure success of thy transplantation surgery. It is critical that you use the meditations exactly as ordered! If you have any questions regarding how to use the medications, please contact our office. Likewise, please do not allow any Of your medications to run out between visits. If you find that you are running low on a medication, please call our office or have your pharmacist call us to have the prescription refilled. Immediately after Surgery you will be taking what seems like a large number of medications. As the transplant heals, the number and frequency of medications will decrease.
For the first few months after surgery, you will need to be examined every several weeks to be certain your eye is accepting the transplant and that there are no other post-operative problems. After 3-4 months your doctor may begin removing sutures which have been holding the transplant in place. This painless procedure is done in the office. All patients heal differently so in some patients only a few sutures are removed, while in others all of them are eventually taken out.
It is important to understand that even after successful surgery the corneal transplant requires considerable time to adjust to its new environment. Therefore, your vision may not begin to improve for several months, and sometimes longer (up to a year).
After the transplant has healed and the appropriate number Of Sutures have been removed, spectacles or occasionally contact lenses may be required to achieve your best vision.
WARNING SIGNS
After you have been discharged from the hospital our biggest concern is that your body may recognize the corneal transplant as a foreign tissue and try to reject it. If rejection of the corneal transplant is going to occur, it will usually happen within the first year after surgery. Your body, however, could begin to reject the cornea at any time for the rest of your life. This is not meant to alarm you, but to reinforce the importance of being observant for changes In the eye that should be checked by your doctor.
Four Major Warning Signs to be Aware of:
Sensitivity to Light: After surgery your eye may be more sensitive to light than normal. This should gradually improve over the first few weeks after surgery. If, however, you notice entreating discomfort when you are in bright light, call your doctor.
Redness of the Eye: Your eye will be red for the first few weeks after surgery. However, lf you notice increasing redness of the eye, especially one or more months after surgery, notify your doctor. You should check for redness of the eye every day by looking in the mirror, or having a family member look at the eye at regular intervals.
Pain: Irritation, mild aching of the eye, and occasionally sharp pains are normal during the first week after Surgery. If, however, the discomfort of the eye is increasing, or lf a deep throbbing pain develops, call your doctor.
Change in Vision: The vision is generally bluer immediately after corneal transplant surgery with gradual improvement over the first several months. You should check the vision in the eye when you get home from the hospital. Pick an object that you can see fairly clearly - this may be a large object such is a lamp or a picture. If your vision is better you may be able to see large letters on a calendar or the headline of the newspaper. Check the vision in the eye every day by looking at the same object from the same distance. Small fluctuations in vision are normal from day to day. If you notice be however, a significant change in vision, or that objects look faded or less distinct, call your doctor.
A SUCCESSFUL CORNEAL TRANSPLANT
As we mentioned earlier, corneal transplantation is the most successful type of transplantation surgery performed today. The prognosis, however, is different for each individual. Even after a technically successful operation, there could be preexisting conditions such as prior surgery, lowercase infection, injury, glaucoma, retinal disease, or disorders of the optic nerve which may admit the ultimate visual outcome. We will discuss with you whether you have any of these conditions which might affect your chances of regaining good vision.
After reading this information you probably realize that corneal transplant surgery is only the beginning of a long process of healing, return visits to the doctor, and instilling medications in your eye. You also probably realize that you, the patient, have an extremely important role in achieving a successful outcome. For the vast majority of patients whose vision has been restored by corneal transplantation, the effort has proven to be well worthwhile.
INSTRUCTIONS FOR YOUR CORNEAL TRANSPLANT SURGERY
The day before your surgery, someone from our Office will contact you to confirm that we definitely have a donor cornea for you. If you have not heard from our office by the afternoon of the day before your scheduled surgery, please call our surgical coordinator at 212-852-2020, ext. 111.
You may receive a call from the Admitting Office of the New York Eye and Ear Infirmary the night before surgery telling you what time to report for admission the following day. This telephone call is only valid if you have received confirmation from our office that we definitely have a donor cornea for your surgery. Otherwise, please disregard their instructions.
In general, if we do not have a cornea available for the day your Surgery is scheduled, one usually becomes available within the following day or two.
If for Some reason you are unable to keep your surgical appointment, or wish to change it for another day, please let us know as soon as possible. We have other patients who are anxiously awaiting their surgery.
BEFORE YOUR EYE SURGERY
Until the day before your eye Surgery, you may participate in all of your routine activities unless you are otherwise Instructed be your doctor.
Take all your regular medications (for high blood pressure, heart, etc.) the morning of surgery with only a small sip of water.
If you are a diabetic and taking oral medications, do not take them the morning of surgery. If you use insulin, please ask the medical doctor who examines you pre-operatively for instructions regarding your insulin dose the morning of Surgery.
If you are taking medications to thin the blood or improve circulation (Such as coumadin persantine, aspirin, etc.) please contact four surgeon for specific instructions.
PRE-OPERATIVE MEDICAL EVALUATION
All patients must have a pre-operative medical evaluation and laboratory tests performed a within thirty (30) days of surgery by:
Your own medical doctor - You will be given a checklist of blood tests and forms to be completed by your own medical doctor. The evaluation must be completed within 30 days of your surgery. You must bring all completed forms, copies of blood tests and x-ray reports (if ordered) with you on the day of Surgery.
OR
Our medical specialist at the time of admission - All tests and forms will be completed after you are admitted.
Remember - Do not Eat or Drink Anyhing After Midnight the Night Before Surgery.
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