A complete pre-operative evaluation will be required prior to surgery. The surgeon will make every attempt to confirm retinal and optic nerve function prior to surgery, so as to avoid cases in which visual improvement is unlikely.
The majority of adult patients may be operated on under local anesthesia. General anesthesia will likely be required for children, anxious or uncooperative patients. After the anesthetic is given, the surgeon sews a ring to the ocular surface to support the eye. The donor cornea is prepared using a punch or corneal trephine to create the corneal “button.” The donor tissue has been procured, processed, and distributed by an eye bank after an exhaustive battery of tests to ensure that it is healthy and ideal for transplantation. The corneal button will become the transplanted cornea. The diseased, or scarred, cornea is then removed using a corneal trephine creating a “bed” for the transplant cornea. Finally, the donor cornea is gently sewn into place with ultra-fine sutures (approx. one-third the thickness of human hair, or less). The sutures remain intact for an extended period of time, and are selectively removed periodically to further enhance the visual outcome. In many instances, a contact lens is required for optimal vision.
In the setting of corneal disease due to the inner layer of the cornea, it is possible to transplant only that layer, without the need for sutures. In these cases, the visual recovery is often more rapid, there is less need for a contact lens to optimize the vision, less ocular discomfort following the procedure, and the integrity of the eye is not compromised. The procedure is performed through a typical cataract wound.