Guest of the Parisian podcast in May 2023, the host Camille Combal talked about his genetic eye disease (the keratoconus, a corneal deformity) and second cornea transplant that he will have to endure. There premiere of his left eye was performed in 2015 : “I have to do law now, I have the other eye to transplant. Both my eyes are affected so I have to do the second one” he explained. What is a corneal transplant? How’s it going ? After ? What success rate ?

Definition: what is a corneal transplant?

“The cornea is the transparent part of the eye that covers the iris and protects us from external aggressions, recalls Dr. Jean-Philippe Theron, ophthalmologist. It is the only part of the eye that can be transplanted. Corneal transplantation consists of replacing the diseased part of a patient’s cornea with a healthy cornea, taken from a donor. In France, the corneal transplant is, by far, the most common type of tissue grafts from of deceased donors (10,000 corneas removed per year). More than 4,000 patients benefit from it each year. “Until the year 2000, transfixing transplants were performed, that is to say they involved the entire cornea. Since then, the great surgical advance lies in the selective replacement of the diseased parts of the patient’s cornea, while preserving the healthy parts as much as possible: these are lamellar grafts.. The cornea is divided into three cell layers:

• the surface epithelium,
• the stroma
• deep endothelium.

The whole is on average between 500 and 600 μ (micron) thick. “By replacing only the diseased part, we limit the risk of rejection”.

Indications: when to do a corneal transplant?

Among the main indications for corneal transplantation, we find in particular:

Today, corneal transplantation is a well-controlled surgical operation that is relatively simple to perform.

• THE keratoconus (corneal deformation of allergic or hereditary origin)
• Primary endothelial decompensations (such as Fuchs endothelial dystrophy).
• Secondary endothelial decompensations (after cataract surgery For example).
• Sequelae related to perforating trauma to the cornea
• Corneal abscess scars

“Will also be concerned all the affections likely to leave as sequelae a corneal opacification and a corneal irregularity.e, continues the doctor. The operation aims to make the cornea transparent And promote light transmission under good conditions“Today, corneal transplantation is a well-controlled surgical operation that is relatively simple to perform.”But it remains a solution of last resort after the failure of an ophthalmic treatment (eye drops)”.

► In first intention, the patient will consult an ophthalmologist who will then refer him to a corneal specialist.

► The doctor will then have to write it down on the national list of patients to be transplanted to the Biomedicine Agency. The wait for an available graft varies from a few weeks to several months. Management of samples and quality controls are carried out by cornea banks and the Biomedicine Agency.

► “As with any operation, the patient will need to carry out a consultation for anesthesia, general (if penetrating graft) or loco-regional (if lamellar graft), and sign an informed consent document“. A complete preoperative assessment will also be carried out.

► The day of the procedurethe patient must arrive with an empty stomach. The surgical procedure lasts between 1 hour and 1h30 depending on the technique. An overnight stay in hospital may be necessary, but the patient may also go home the same day, with a post-operative visit the next day, without overnight stay. “The patient is placed on his back in a sterile surgical environment and under a microscope. The surgeon will open the eye and replace the defective cornea with another healthy cornea (the graft). Since we are transplanting a tissue and not an organ, there is no compatibility problem between the donor and the recipient. In addition, the cornea is not irrigated with blood vessels and the cells that constitute it express very little of the antigens responsible for rejection.“. The corneal transplant is related to the donation of a deceased person. “And there is a real deficit in France“.

What are the precautions to take after a corneal transplant?

Post-operative treatment includes only local treatments. “Antibiotic eye drops and/or ointments And corticosteroid eye dropsthe main preventive weapon against rejection during a period of 6 to 12 months, According to the case“, details our interlocutor. The frequency of instillation will decrease over time. “Ophthalmological monitoring must therefore be rigorous and lifelong.and any anomaly reported quickly to the doctor (pain, decreased vision, red eye)“.

The patient must identify the emergency signs: redness in the eye, pain, photophobia, reduced vision, tearing.

What is the success rate of a corneal transplant?

“The success rate of corneal transplants fluctuates between 60 and 90% of casesemphasizes Dr. Théron. Depending on the case, it is possible to redo a corneal transplant in the event of failure.“.

How long does it take to recover after a corneal transplant?

“After the operation, the eye being weakened, it is recommended to stay 1 quiet week at home and wear sunglasses in case of discomfort in the light“, concludes our doctor.

What are the risks of a corneal transplant?

“The main risk remains the rejection of the corneal transplant, answers the specialist. It is linked to the recognition by the body of the recipient of the antigens of the graft“. The patient must be able to spot the emergency signs: eye redness, pain, photophobia, decreased vision, tearing. An emergency consultation is essential in this case. “The risk of rejection is 15% at 5 years for penetrating grafts, and 2% at 5 years for lamellar grafts.. Treatment of rejection is based on intensive local corticosteroid therapy (eye drops, tablet or injection). The post-operative risk of infection is weak. A post-operative follow-up is scheduled every month for a period of 6 to 12 months.

Thanks to Dr Jean-Philippe Théron, ophthalmologist at the ophthalmic institute of Somain (59)