Keratoplasty (corneal transplant); penetrating (in pseudophakia)
CPT4 code
Name of the Procedure:
Keratoplasty (corneal transplant); penetrating (in pseudophakia)
Summary
A penetrating keratoplasty, also known as a full-thickness corneal transplant, is a surgical procedure where a damaged or diseased cornea is replaced with a donor corneal tissue. When performed in pseudophakia, it means the patient already has an artificial lens implant from a previous cataract surgery.
Purpose
Penetrating keratoplasty addresses corneal conditions that impair vision, such as keratoconus, corneal scars, or dystrophies that cannot be corrected with glasses or contact lenses. The goal is to restore clear vision and improve the overall quality of life.
Indications
- Corneal scarring from previous injury or infection
- Advanced keratoconus
- Fuchs' dystrophy
- Corneal degeneration
- Failed previous corneal transplant
Patients qualifying for the procedure usually have significantly impaired vision that affects daily activities, and other treatments have proven ineffective.
Preparation
Patients will need to:
- Fast for at least 8 hours before the surgery.
- Adjust current medications as per the surgeon’s advice.
Preoperative tests may include:
- Comprehensive eye examination
- Corneal topography
- General physical assessment and blood tests
Procedure Description
- The patient receives local or general anesthesia.
- The surgeon makes a circular incision in the diseased cornea to remove the central portion.
- A matching donor cornea is stitched into place using fine sutures.
- Antibiotic and anti-inflammatory medications are applied to prevent infection and control inflammation.
Duration
The procedure typically takes about 1 to 2 hours.
Setting
The surgery is usually performed in a hospital or specialized surgical center.
Personnel
- Ophthalmic surgeon
- Surgical nurses
- Anesthesiologist
Risks and Complications
Common risks:
- Infection
- Elevated intraocular pressure
- Suture complications
Rare but serious complications:
- Graft rejection
- Severe inflammation
- Prolonged visual impairment
These risks are managed with close postoperative monitoring and medications.
Benefits
The procedure can significantly improve vision, allowing patients to return to normal activities. Benefits are typically realized within a few weeks to months after the surgery as the eye heals.
Recovery
Post-procedure care includes:
- Using prescribed eye drops to prevent infection and control inflammation.
- Wearing an eye shield for protection.
- Attending follow-up appointments to monitor healing. Full recovery may take several months, and patients should avoid strenuous activities and contact sports during this period.
Alternatives
- Phototherapeutic keratectomy (PTK)
- Lamellar keratoplasty (partial thickness transplant)
- Custom contact lenses
Each alternative has its benefits and limitations depending on the specific condition of the eye.
Patient Experience
During the procedure, the patient will be under anesthesia and should not feel pain. Postoperatively, mild discomfort, light sensitivity, and blurred vision are common but can be managed with prescribed medications. The care team ensures patient comfort through pain management and supportive measures throughout the recovery phase.