Keratoplasty (corneal transplant); penetrating (except in aphakia or pseudophakia)
CPT4 code
Name of the Procedure:
Keratoplasty (corneal transplant); penetrating (except in aphakia or pseudophakia).
Summary
Keratoplasty, commonly known as a corneal transplant, is a surgical procedure where a damaged or diseased cornea is replaced with a healthy donor cornea. This specific type, penetrating keratoplasty, involves the full-thickness replacement of the central corneal tissue.
Purpose
Penetrating keratoplasty aims to restore vision in patients with corneal opacities, scarring, or thinning that cannot be treated with other methods. The goal is to improve visual acuity, reduce pain, and address corneal deformities.
Indications
- Severe corneal scarring from infections or injuries
- Keratoconus where other treatments have failed
- Corneal dystrophies and degenerations
- Corneal edema or swelling
- Rejection of a previous corneal transplant
Preparation
- Patients may need to fast for several hours before the procedure.
- Certain medications may need to be adjusted or paused.
- A comprehensive eye examination and possibly corneal measurements will be required.
- Blood tests and donor matching may be conducted.
Procedure Description
- The patient receives local or general anesthesia.
- A circular cut is made in the damaged cornea using a trephine.
- The donor cornea is similarly cut to match the size of the removed cornea.
- The donor cornea is sutured into place on the patient's eye.
- The surgeon checks for proper placement and alignment and may adjust sutures as needed.
Duration
The procedure typically takes between 1 to 2 hours.
Setting
Penetrating keratoplasty is generally performed in a hospital or specialized outpatient surgical center.
Personnel
- Ophthalmic surgeon
- Anesthesiologist or nurse anesthetist
- Surgical nurses and technicians
Risks and Complications
- Infection
- Bleeding
- Rejection of the donor cornea
- Increased intraocular pressure
- Astigmatism or irregular curvature of the new cornea
- Need for subsequent surgeries
Benefits
- Significant improvement in vision
- Pain relief if the patient had painful corneal conditions
- Enhanced quality of life Patients may notice vision improvements within weeks but full recovery and maximum vision improvement can take several months.
Recovery
- Patients will need to use prescribed eye drops to prevent infection and rejection.
- Wearing an eye shield, especially during sleep, to protect the eye.
- Avoid strenuous activities and swimming until cleared by the doctor.
- Regular follow-up visits for monitoring and suture adjustments are necessary. Recovery can take between 6 months to a year.
Alternatives
- Phototherapeutic keratectomy (PTK)
- Deep anterior lamellar keratoplasty (DALK)
- Endothelial keratoplasty (DSEK or DMEK) Each alternative has its pros and cons, depending on the specific condition of the patient's cornea.
Patient Experience
- Patients may feel some discomfort or mild pain after the procedure, manageable with medications.
- Vision might be blurry or hazy immediately after the surgery but will gradually improve.
- Use of anesthetics ensures that the patient is comfortable during the surgery.