1) Indication
2) Source of material
3) Rejection risk
4) How is rejection treated
5) Visual rehab
6) Resume normal activities
7) Surgical detail / will eye colour change
8) Medical aids / Costing
9) Contact with donor family
10) Post op care
1) What are the indications for corneal transplant?
- Optical: To restore vision by replacing the opaque or physically distorted (astigmatism) corneal tissue with clear, non distorted healthy tissue from a donor. These are typically keratoconus patients and corneas scarred following trauma or infections
- Reconstructive: to restore the corneal anatomy in patients with extreme thinning and perforations
- Therapeutic: To remove inflamed corneal tissue which is not responding to medical therapy
- Cosmetic: To improve the appearance of white opaque corneal scars
2) Where are donor corneas sourced from?
Corneas are sourced from local and/or overseas ‘eye banks’. The donor tissue is rigorously inspected for suitability and safety i.e. HIV free and free of pre-existing corneal disease or past corneal surgery. The corneal tissue must be used within 14 days of ‘harvesting’ and is transported in a chilled growth medium containing antibiotics
3) What is the risk of graft failure?
Corneal tissue “fails” i.e. loss of transparency with consequent drop in vision due to endothelial cell counts dropping below a critical level. Most cases are due to rejection and repeated ophthalmic procedures (as with repeated transplants). Fortunately, corneal rejection is uncommon and if it occurs can be treated medically in most circumstances.
Most corneal transplants ‘last’ well beyond 10 years! Corneal transplant patients require bi-annual ophthalmic checkups to ensure optimal eye health.
4) How soon does my vision become functional?
This varies enormously from patient to patient and which transplant technique was employed to execute the procedure. 
In general, using the new Femto laser technique, patients achieve navigational vision without contacts or glasses within 2 to 3 weeks. At 6 to 7 months post surgery, when some or all of the sutures are removed, most patients have 6/12 or better vision with glasses or contacts.
The older technique (PK using a trephine) has a much longer recovery period. A similar outcome is achieved in 18 months on average.
Laser vision correction can be performed after corneal transplantation – to achieve glasses or contact lenses independence. The timing of this depends on the cornea's stability.
5) When can I resume normal activities?
This is variable but in general resuming normal activities like gym, golfing etc is much sooner after the new Femto laser corneal transplant technique. Within 1 month most normal activities can be safely resumed.
6) What surgical techniques are there?
The older trephine (hand held blade system) is still widely used. However, the incisions are weak and consequently sutures remain in situ for at least a year post op. Post operative astigmatism is usually very high recquiring hard contact lenses to correct vision.
However, the newer Femto dalk technique uses a precise laser to remove only the abnormal corneal tissue whilst conserving the patient’s own endothelial cells (less risk of rejection). Furthermore, with early removal of sutures (due to much stronger wounds after laser) result in earlier visual rehabilitation within 7 months as opposed to the 18 months with the older techniques.
7) Will my eye colour change?
No, your eye colour stays exactly the same. The transplant involves only the transparent clear cornea and not the pigmented iris!
8) Do medical aids cover the cost of a corneal transplant?
This depends entirely on which technique is used. Medical Aids will generally cover the older method in full and will contribute towards the cost of a procedure done with a Femto laser but don’t cover the entire cost. Please contact your medical aid advisor for details in your contract pertaining to transplantation. There is usually no/little cover for the laser utilization in the new technique. You will need to ‘top up’ this cost. Costs for transplant differ between the older techniques (cheaper) and the new laser technique (more expensive)
9) Can I contact the donor family?
Typically, donor families wish to remain anonymous but the donor Eye bank can be approached to pass on recipient’s thoughts if appropriate.
10) How do I care for my transplant?
General principles apply: bi- annual ophthalmic checkups, sunglasses when outdoors (polarized), healthy diet and a high index of suspicion of rejection i.e. sudden onset of light sensitivity, redness and changing vision.