While much recent activity around treatment of keratoconus is crosslinking-related, corneal transplants remain an important option to treat keratoconus. About 20% of patients with KC – those with advanced cases whose vision cannot be corrected by non-surgical means – are candidates for corneal transplant surgery.
Nearly 50,000 corneal transplants are performed in the U.S. each year, and 95% of these operations successfully restore vision. Despite success, patients must continue to work with their eye surgeon to monitor the health of their transplant after the procedure. “Appropriate follow-up is essential to ensure the integrity of the graft,” according to Dr. Laurence Sperber, MD, Clinical Professor and Director of the Cornea Service at NYU Langone Medical Center in New York City (pictured right).
“The risk of corneal transplant rejection is highest in the first 2 years after the transplant, but it remains a concern throughout the patient’s lifetime.”
In the first year after the transplant, the patient is examined very frequently (at least every 1 -2 months) to monitor progress and watch for signs of rejection. During this time, the patient’s astigmatism is monitored and sutures are removed to adjust this until a satisfactory visual outcome is attained. Depending on the location of the ‘cone’, the cornea may be flatter and there may be noticeable improvement in vision for KC patients. After the healing process is well underway, patients may be fitted for a new set of contact lenses.
Dr. Sperber noted that in addition to concerns about visual rehabilitation, patients are also taking drugs to reduce the chances of a graft rejection. “The postoperative steroid drops are slowly tapered and, in many cases, discontinued by the end of the first year.” Sperber reports that during this time, the doctor will monitor the patient’s response to decreasing the steroid drops; any increase in inflammation or other signs of rejection are reason to increase the steroid drops and delay their discontinuation. In some cases, a corneal transplant patient will continue to take these eyedrops over their lifetime.
After the initial year, the patient is seen 2 – 4 times a year to monitor for rejection or any other changes in the transplant. Dr. Sperber warned that even years later, the surgeon will be looking for signs of graft rejection, graft swelling, or other problems which could indicate that the survival of the transplant is in jeopardy. (See our related story about rare but documented cases of keratoconus in patients who have undergone corneal transplant.)