Duration of corneal transplantation
On the day of the operation itself, the patient either remains in hospital overnight or is discharged home the same day (outpatient procedure), but must then go to an ophthalmologist‘s office for a check-up the following day. The vision of the treated eye will not be fully restored in the first few days immediately following the operation. Therefore, increased caution in everyday life and especially in road traffic is recommended.
As a rule, special precautions are not necessary, except that the patient should take care of his eye and protect it from mechanical stress, i.e. do not rub it. Eye drops containing cortisone and antibiotics promote the healing process. Over the next few weeks to months, an ophthalmologist should check the eye regularly to assess the progress.
Since the new cornea may be numb for about a year after the transplant, the patient should avoid activities such as drilling, welding, chiselling, etc. to protect the eye from dust. When the right time for removal of the sutures has come, is decided by the treating ophthalmologist during one of the control examinations. Usually this is after nine to twelve months, but can extend to two years in individual cases. After the stitches have been removed, the eye will normalize completely and new glasses can now be fitted if necessary, as the eye will probably not change any further.
Costs of corneal transplantation
The patient does not normally have to worry about the costs of a corneal transplant. The costs are covered by the statutory health insurance (GKV). However, they only pay for the standard treatment, as is usual for other procedures.
Any additional treatment that the patient wishes to receive must be paid for by the patient himself. With private health insurances (short PKV) the whole thing looks a bit different. Here, the insurance company decides in each individual case and depending on the conditions of the insurance.
Normally, however, any additional costs for special treatments are also covered. Whether corneal transplantation is necessary at all is of course decided by the treating doctor. The doctor will then apply to the statutory health insurance company for reimbursement of the costs and prove that the diagnosis made is correct and that the corneal transplant is unavoidable.
Since this is now a routine procedure, the reimbursement of costs is usually quick and unproblematic. Similar to liver or kidney donations, there is a chronic shortage of donors in Germany. Of all transplantations, corneal transplantation is the most common transplantation performed in medicine.
The supply-demand ratio is also favorable for corneas of the eye, so that most patients who need a cornea can be transplanted relatively quickly. The cornea of the eye has many different tasks. In addition to contributing to sharp vision through the additional refraction of incident light, the cornea also has the additional task of protecting the eye from bacterial and viral invaders, and it also leads to a cushioning of the intraocular pressure.
Escaped aqueous humor is also pumped back into the eye through the cornea. Cornea cannot regenerate. Once it is severely damaged, the cornea must be transplanted as the only therapeutic option to save the patient’s eyesight.
Reasons for corneal transplantation are therefore damage caused by corrosive substances (industrial accident), perforations and punctures, but also foreign bodies that have reached the cornea and are left there can cause scratching of the cornea due to the eyelid being raised and lowered. Less frequently, infections and complications of previous eye operations are reasons for corneal transplantation. Corneal injuries can either be seen with the naked eye (in the case of extensive injuries) or by using a slit lamp with fluorescent fluid.
This liquid stains small scratches and scars yellow. If only the superficial layer of the cornea is scratched, a so-called lamellar corneal transplantation can be performed, in which only the uppermost layer of the cornea is transferred. If deeper layers of the cornea are also scratched, it must be transferred in its entire thickness during corneal transplantation.For this purpose, the cornea of a dead person is removed and placed in a nutrient solution, whereby a shelf life of several days can be achieved.
It is important that the cornea removal should be performed within 12-18 hours after the death of the donor, as this is the only way to achieve the necessary vitality. From the removed cornea, a few micrometers thick layer is then cut out with a fine knife into a form that is cut out of the recipient’s cornea. The then transferred cornea is then sutured with a continuous suture or with single button sutures at the recipient.
The sutures must remain for approx. 12 months. How fast a transplanted cornea grows depends on the vitality of the transplanted material and the occurrence of complications.
Transplant rejections can occur after corneal transplantation and are usually noticeable by a foreign body sensation in the eye. It is important that in this case an ophthalmologist is consulted within one day. In order to prevent transplant rejections, the donor organ can be tissue-typed, and the recipient can be given an immuno-throttling therapy (Ciclosporin A) after the corneal transplantation.
Vascular-free grafts lead to rejection reactions less frequently than vascular grafts. Corneal transplantation is the most common medical organ transplantation in Germany.
