Since the 1990s, the field of corneal surgery has been characterized by rapid developments. These make the surgical treatment of corneal diseases possible and reduce risks and side effects. Modern corneal surgery has a good chance of success. Corneal transplantation is one of the most common corneal operations.
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The cornea of the eye consists of different layers and protects the sensitive interior of the eye. It is clear and needs regular lubrication with tears. The curvature of the cornea refracts the incident light so that it also contributes to sharp vision.
The cornea and its layered structure
Diseases can lead to clouding of the cornea so that the eye does not absorb enough light. This impairs vision and can also lead to blindness.
This process can be prevented by a corneal transplant or the implantation of an artificial cornea.
Corneal surgery is advisable if there is a disease that impairs vision or threatens blindness.
These diseases include
Preliminary examinations make it clear whether corneal surgery is necessary
Below we briefly present some common corneal surgery procedures.
A corneal transplant involves the donation of tissue from a deceased person. The patient is placed on a waiting list. As soon as a suitable cornea is available, doctors remove it and transplant it into the recipient within 72 hours.
To do this, doctors cut out the healthy and diseased cornea in a precise circular shape. This is done using a laser or scalpel.
They then insert the donor's cornea into the recipient's eye and suture it. The more precise the incision, the better the healing process.
In 20% of corneal transplants, a rejection reaction occurs within five years. After 15-20 years, a new transplant is often necessary, as the density of the cornea decreases more quickly than the patient's own cornea.
Eye after a corneal transplant
Occasionally it is necessary to wear a special contact lens after the operation.
In lamellar keratoplasty, doctors only replace the diseased layer (lamella) of the cornea. This procedure is gentler than a complete transplant and leads to better long-term results.
The corneal transplant is performed in an operation lasting around 60 minutes under general anesthesia. The patient then remains in hospital for about a week.
As there are not an unlimited number of donor corneas available, an artificial replacement cornea would be a great advantage. However, the problem is that the body's own tissue does not grow together with artificial tissue.
Therefore, the use of transparent, artificial material is not possible. Researchers are working intensively in this field. There are already approaches to solving this problem.
So far, these methods are either cosmetically unfavorable (osteo-odonto-keratoprosthesis) or very expensive. The use of an artificial cornea is therefore still in the development phase.
Corneal crosslinking is used for keratoconus patients. The aim is to stabilize the cornea through crosslinking and to stop the progressive protrusion of the keratoconus.
The specialist uses a photochemical process for this. Irradiating the cornea with UV light activates the B2 vitamin riboflavin and releases oxygen radicals. These bind the carbon and nitrogen groups of the collagen fibers together. In this way, they cross-link with each other and thus increase the stability of the cornea.
The advantage of this method is that no foreign material or incisions are required. The prognosis is therefore much better.
It is also possible to improve visual acuity, as crosslinking flattens the protrusion in some cases.
A corneal laser removes diseases and defects of the cornea that only affect the outer layers.
The corneal laser is suitable for
The prerequisite is that the defects do not extend too deep into the cornea. Stability must also be maintained by removing the diseased layers.
After corneal surgery, the patient must initially wear a contact lens for a few days to protect the cornea.
Diseases of the cornea can lead to blindness. Replacing the cornea is not as difficult as replacing the lens of the eye.
The aim of corneal surgery is to prevent blindness or to restore vision. Advances in ophthalmology make it possible to avoid corneal replacement with crosslinking or the corneal laser.
However, corneal surgery is also associated with risks, such as
In the case of corneal transplantation, there is also the risk of rejection and immune reaction.
The first signs are
There may also be a loss of certain cells from the donor material, meaning that a new transplant is necessary in the near future. As with any medical procedure, corneal surgery is also associated with risks. These begin with general anesthesia and include complications associated with corneal surgery.
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