Cornea Transplant
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Corneal transplantation is an effective treatment for patients with corneal disease or scarring and refers to the replacement of all or part of the cornea (the clear window of the eye) with a donor cornea. The procedure has been revolutionised in the past 10-20 years since it was it performed in the early 1900s. During all types of corneal transplantation, the diseased part of the patient’s cornea is removed and replaced with healthy corneal tissue from a human donor.
The treatment is recommended for any patient with significant corneal disease or scarring not amenable to glasses, contact lenses or CXL. Some conditions include:
- Keratoconus
- Inherited corneal conditions such as Fuchs endothelial dystrophy
- Corneal scarring following infection or injury
- Failed previous corneal transplants
Our corneal surgeons at Re:Vision are experienced in performing all forms of corneal transplantation including full thickness or partial thickness grafts:
- Penetrating keratoplasty (PK)
- Deep Anterior Lamellar Keratoplasty (DALK)
- Descemet's stripping automated endothelial keratoplasty (DSAEK)
- Descemet's membrane endothelial keratoplasty (DMEK)
What is Glaucoma?
Glaucoma is a disease that damages the nerve at the back of your eye, called the optic nerve. The optic nerve sends the signals to the brain that enables you to see. Glaucoma is associated with increased sensitivity to pressure within the eye. The eye’s aqueous fluid is constantly produced and drained at a balanced rate and forms the intraocular pressure within the eye (IOP). When this drainage is reduced, or if there is too much fluid production, IOP increases and leads to damage of the optic nerve.
Image of the optic nerve showing loss of nerve cells in patients with glaucoma.
Glaucoma typically has no symptoms. Most patients do not experience any issues until they visit their eyecare provider. Untreated glaucoma can cause a gradual loss of vision, usually starting in the periphery which may go unnoticed for long periods of time.
Image showing the effect of loss of sight in patients with glaucoma.
Our Process :
Assessment
Detailed measurements of the eyes are taken for safety and accuracy, and your surgeon will discuss your options. If you wear contact lenses, please leave them out and wear glasses for two full days prior to the day of your assessment.
Meet your surgeon
Your surgeon who will thoroughly examine your eye and discuss your cornea transplant options. Our surgeons have published widely on corneal transplant surgery and its different types.
On the day
The corneal transplant procedures are very different in nature and can be performed under local or general anaesthesia. Your surgeon will provide a customised treatment plan for you based on your condition.
Check
A follow-up appointment is usually made the next day after your surgery. The recovery following corneal transplantation depends on the type of procedure. Your surgeon will exaplin the recovery process in detail based on your condition.
5 most common reasons patients have LASIK eye surgery :
Improved Vision :
LASIK can significantly improve high definition vision, allowing people to see clearly without relying on glasses or contact lenses. This is a huge benefit for people who’ve been struggling with poor vision for years.
Convenience :
For those always on the go or have an active outdoor lifestyle, a life not limited by glasses or contacts is a huge lift.
Cost Savings :
Over time, the cost of glasses and/or contact lenses, all add up. LASIK is a very cost-effective solution to reduce long-term expenses related to vision correction.
Safety :
With advances in laser technology, the small risks associated with LASIK have become increasingly minimal. Risks are minimised by choosing an experienced specialist laser surgeon who uses the latest laser technology.
Improved Self-Confidence :
For many, wearing glasses or contact lenses can be a source of self-consciousness. LASIK helps to improve self-confidence and allow people to feel more comfortable in their own skin.
Saving money
The hidden costs: what could you save?
What could that money have done?
The $40,000 you'd potentially spend on glasses and contact lenses over the next 30 years could have given you 15 luxurious holidays.
Est - 15 Holidays
Average holiday cost: $2600
Calculation: 40,000 / $2600 = 15
Saving time
The hidden cost of wearing glasses or contact lenses.
Did you know?
The time you'd spend handling glasses and contact lenses over the next 30 years is enough to have could have taken you around our planet over 30 times!
Est- 526 hours
Cleaning: 3 minutes/day
Finding misplaced glasses: 2 minutes/day
Repair, shopping: 2 hours/year
Total: 526 hours (over 30 years)
Est- 526 hours
Inserting and Removing: 3 minutes/day
Cleaning: 2 minutes/day
Renewing & Check-ups: 2 hours/year
Total: 1,012 hours (over 30 years)
Saving planet
Reducing our carbon footprint
The environmental perspective
Over 30 years, using glasses and contact lenses contributes to 876lb of CO2 emissions. Opt for vision correction and take a stand for our planet!
Est- 876.6 CO2 emissions
Combined plastic waste:
0.525 kg (glasses)+65.7 kg (contact lenses)=66.225 kilograms over three decades.
Total: 66.225 kilograms of plastic×6=397.35 kilograms = 876Lb of CO2 emissions(over 30 years)
Benefits of corneal transplantation
Safe
Our surgeons are experienced in performing the latest partial thickness corneal transplant techniques, which provide where just the affected part of the cornea is transplanted. In DMEK surgery, a layer that is just 10 microns thick is transplanted, resulting in quick visual recovery and minimal risk of rejection.
Fast Recovery
Partial thickness cornea transplant surgery allows for fast recovery, with useful vision returning within 5-7 days.
Proven
Corneal transplant surgery has been around for over 100 years, with numerous studies proving its effectiveness. Our doctors have performed over 1000 cornea transplant procedures and published on the safety and efficacy of various corneal transplant surgeries.
Personalised Surgical Care
Some patients are not suitable for drops or laser therapy and require either cataract surgery, minimally invasive glaucoma surgery or complex glaucoma surgery.
Minimally invasive Glaucoma surgery (MIGS) marks a milestone in the advancement of glaucoma patient care. MIGS are a form of glaucoma surgery which is associated with minimal incisions, and are generally associated with lower risks in restoring normal eye pressure.
Prior to MIGS, treatment options were limited to medications, laser and major glaucoma tube and filtration surgery. Now, with MIGS, our team at Re:Vision have more treatment options which benefits a patient with faster recovery , less surgical risks and less dependence on medications following surgery.
Our surgeon is a leader in MIGS surgery in NZ, with a wealth of experience with iStent -W, Kahook Dual Blade, Hydrus, XEN, Preserflo, micropulse and cyclodiode laser.
MIGS management include:
1) Various treatment options and benefits which are patient centric and individualised
2) Evidence based therapy and
3) Promising outcomes for glaucoma patients.
MIGS can be performed as a standalone procedure or in conjunction with cataract surgery. There are different surgical approaches under the MIGS umbrella, but they generally are designed to allow more fluid to drain out of the eye and hence, reduce intraocular pressure.
a) iStent
The iStent is the smallest medical device ever implanted into humans. The iStent decreases eye pressure by creating a pathway into the eye’s drainage system. The iStent was the first trabecular micro-bypass device approved by the FDA and is the most thoroughly-studied glaucoma device on the market.
Click here to watch video on iStent
b) Kahook Dual Blade
The Kahook Dual Blade goniotomy procedure involves removing a section of the trabecular meshwork (the part which is associated with the greatest resistance in fluid outlflow) and hence increasing drainage out of the eye.
Click here for information on KDB
c) Micropulse Laser Treatment
This procedure decreases the amount of fluid produced by the eye and increases fluid outflow. A probe is placed on the surface of the eye and the surgeon applies laser energy to part of the eye which controls the production of fluid in the eye.
d) Preserflo Stent
The Preserflo drainage shunt is type of microshunt implant used to reduced intraocular pressure by creating a controlled pathway for the drainage of fluid out of the eye. It is made from a specialised biocompatible material called SIBS, which is known for its stability, flexibility and compatibility with the human body, hence minimising tissue inflammation.
Click here for information on Preserflo
Trabeculectomy surgery has been done for more than 50 years, and involves making a separate channel for fluid to filter out of the eye.
A drainage tube is a device inserted into the eye, which acts as straw where fluid can access to drain out of the eye onto the outer coat of the eye. There are several drainage tubes available in NZ which include Molteno drainage tube, Paul drainage tube and Baerveldt drainage tube.
Generally, these surgeries are done once all others have been exhausted and have failed to stop the progression of glaucoma.
Glaucoma is optic nerve damage due to increased pressure sensitivity within the eye while a cataract is a clouding of your natural lens within your eye.
In some patients, the hardening and change in the shape of the lens with the development of cataract, can potentiate the effects of glaucoma, such as angle closure glaucoma. In this situation, we may suggest having cataract surgery as a way to treat your glaucoma.
Some patients can combine glaucoma and cataract surgery (includes patients with open angle glaucoma). MIGS procedures in particular can be performed through the same incision as cataract surgery, providing an efficient way to address two problems at once.
Our Technology:
Sirius Tomographer
Combines Placido disk topography with Scheimpflug tomography of the front of the eye to allow the surgeon to perform the safest version of laser vision correction customised to your eyes. The device provides highly accurate measurements of corneal thickness, curvature, power as well as pupil size measurements and is commonly used for refractive surgery planning and follow-up.
Triton Swept Source OCT
This Swept Source OCT provides a significant improvement over conventional OCT. Due to the optimized long wavelength scanning light (1,050nm), there is better penetration of the deeper layers of the eye. This device takes 100,000 scans per second to provide better accuracy and is able to scan teh entire cornea in a matter of seconds.
Glaucoma Research at Re:Vision
Dr Perumal values the importance of research initiatives and technology in glaucoma. We may invite you to participate in the Save Sight Registry run by the Save Sight Institute, in collaboration with the University of Sydney and Sydney Eye Hospital to fight glaucoma blindness.
The Save Sight Registries is one of the most advanced ophthalmic registries in the world, and is a unique platform for tracking eye disease, interventions and patient outcomes. Its sophisticated design delivers real-world evidence on the risks and benefits of current and new treatments for ocular conditions. This information helps clinicians provide safe, cost-effective and evidence-based solutions for vision impairment and avoidable blindness.
The Save Sight Registries also promotes international scientific research aimed at developing strategies for reducing the incidence of blindness throughout the world.
How much does corneal transplantation cost?
At Re:Vision, all types of laser vision correction (LASIK or PRK) cost : $3,599/eye
Cornea transplantation costs are usually covered by most insurance companies. Exact costs depend on the type of cornea transplant best suited for you.
By the time I turn 45, I will have spent on contact lenses/glasses :
At Re:Vision, all types of laser vision correction
(LASIK or PRK) cost : $3,599/eye
Get Started
References :
- Huang V, Singh V, Ziaei M, McKelvie J. Double anterior chamber following deep anterior lamellar keratoplasty with endothelium-on donor tissue. Can J Ophthalmol. 2022 Jun 16:S0008-4182(22)00172-7.
- Al Mahrouqi H, Tavassoli S, Ziaei M. Corneal Transplantation, Surgical management of refractive error following corneal transplantation, Jaypee Medical, 2022
- Zhang J, Ziaei M, McKelvie J, McGhee CNJ, Patel DV. Integration and remodelling of a collagen anterior lamellar keratoplasty graft in an animal model - A preliminary report. Exp Eye Res. 2021 Jun 5;209:108661
- Alió Del Barrio JL, Bhogal M, Ang M, Ziaei M, Robbie S, Montesel A, Gore DM, Mehta JS, Alió JL. Corneal Transplantation after Failed Grafts: Options and Outcomes. Surv Ophthalmol. 2020 Oct 13:S0039-6257(20)
- Gokul A, Angelo L, Vellar H, Ziaei M. Biomechanics in DALK: Big bubble vs Manual lamellar dissection, Arquivos Brasileiros de Oftalmologia 83(4), 2020
- Ziaei M, Vellara HR, Gokul A, Ali NQ, McGhee CNJ, Patel DV. Comparison of corneal biomechanical properties following penetrating keratoplasty and deep anterior lamellar keratoplasty for keratoconus. Clin Exp Ophthalmol. 2019.
- Ziaei M, Gokul A, Patel DV, McGhee CNJ. Descemet membrane endothelial keratoplasty for treatment of iridocorneal endothelial syndrome. Can J Ophthalmol 2018; 53: 226-9.
- Ziaei M, Ziaei F, Manzouri B. Systemic cyclosporine in corneal transplantation. Int Ophthalmol, 2016. 36(1):139-46.
- Alió del Barrio J, Ziaei M, Bhogal M, Allan B. Femtosecond Laser-Assisted Deep Lamellar Endothelial Keratoplasty: A New Approach to a Forgotten Technique. Cornea. 2015. 34(11):1369-74.
- Keane M, Coster D, Ziaei M, Williams K. Deep anterior lamellar keratoplasty versus penetrating keratoplasty for treating keratoconus. Cochrane Database Syst Rev. 2014.
- Ziaei M, A. Barsam, and A.A. Mearza. Spontaneous corneal clearance despite graft removal in Descemet stripping endothelial keratoplasty in Fuchs endothelial dystrophy. Cornea, 2013. 32(7): p. 164-6.
- Ziaei M, Sharif-Paghaleh E, Manzouri B. Pharmacotherapy of corneal transplantation. Expert Opin Pharmacother, 2012. 13(6): p. 829-40.
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