Clearer Skies web3 - Centre for Eye Research Australia · 2014-08-19 · CLEARER SKIES AHEAD Corneal Recipient Information Brochure. Information about your corneal transplant A project

CLEARER SKIES AHEADCorneal Recipient Information Brochure

Information about your corneal

transplant

A project of the Lions Clubs of Victoria and Southern NSW in association with the Centre for Eye Research Australia and The Royal Victorian Eye and Ear Hospital.

www.eyedonation.org.au

THE INFORMATION IN THIS BROCHURE IS INTENDED TO SUPPLEMENT, NOT SUBSTITUTE, THE EXPERTISE

AND JUDGEMENT OF YOUR OPHTHALMOLOGIST. YOUR OPHTHALMOLOGIST SHOULD BE CONSULTED

PRIOR TO MAKING YOUR DECISION REGARDING ANY EYE TREATMENT OR SURGERY.

WHAT IS A CORNEA?The cornea is the clear window at the front of the eye. It allows light to enter the eye and does most of the focusing for the eye.

The cornea must be clear to allow light to pass into the inside of the eye. It must also have a regular curve to properly focus the light. Injury, disease, or hereditary conditions can cause clouding, distortion or scarring of the cornea which may interfere with vision. Vision may then only be improved by replacing all or part of the cornea by a corneal transplant.

WHAT IS A CORNEALTRANSPLANT?Corneal transplantation is an operation that involves replacement of abnormal cornea with all or part of a healthy clear cornea from a donor’s eye.

Corneal transplants may be full-thickness (penetrating keratoplasty) or partial thickness (lamellar keratoplasty).

WHO NEEDS ACORNEAL TRANSPLANT?There are many conditions for which a person might need a corneal transplant. Some of these include:

• Keratoconus, a condition that causes progressive thinning of the cornea

• Corneal clouding caused by certain corneal conditions such as Fuchs’ Corneal Endothelial Dystrophy, which causes the cornea to become swollen and cloudy

• Infections of the cornea which may be caused by bacteria, fungi or viruses

• Corneal injuries caused by sharp objects such as knives, pencils or metal fragments

• Chemical injury caused by exposure of the eye to toxic chemicals











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ARE THERE ALTERNATIVES TO CORNEAL TRANSPLANTATION?This depends on the specific condition affecting the cornea and the individual circumstances.

If vision in your other eye is excellent and only one eye is affected, then it may be possible to avoid corneal transplantation, but it may be the only way to improve vision in the affected eye.

If your eye is painful but has little or no chance of improved vision, in some cases there may be other surgical options.








OPTIONS











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Clockwise from left:1. keratoconus2. cloudy cornea3. a corneal transplant in place

WHAT ABOUT THE ARTIFICIAL CORNEA?The artificial cornea may be possible in some rare cases and as a last resort. It is not suitable for all eyes in need of corneal transplantation, but may be a possibility for those with specific problems or where corneal transplants have failed several times before.

HOW SUCCESSFUL IS A CORNEAL TRANSPLANT?Of all transplant surgeries done today, corneal transplants are by far the most common and successful. Overall success rates are better than 90% after 1 year, and 74% at 5 years.

Some conditions, such as keratoconus, have even higher success rates (98%).

BACKGROUND5

HOW SAFE IS THE DONOR CORNEA?The medical histories of all donors are screened thoroughly before the corneas are removed. The donor’s blood is also tested for communicable disease to reduce the chance of transmission of infectious diseases.

Corneas are removed from the donor using a sterile surgical technique and evaluated at the Lions Eye Donation Service to ensure they are suitable for transplant.

WHERE DO THE DONOR CORNEAS COME FROM?The corneas used for transplantation are human tissue. They have been generously donated by the families of recently deceased relatives.

The Lions Eye Donation Service is responsible for the surgical retrieval, evaluation and distribution of these corneas. The Commonwealth Government’s Therapeutic Goods Administration licenses it for these purposes.

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HOW LONG DO I HAVE TO WAIT FOR A CORNEAL TRANSPLANT?When you and your surgeon determine that you require a corneal transplant, you will be given a date for surgery.

This date will depend on several factors, such as availability of the surgeon, the anaesthetist and operating theatre, your own wishes and importantly, an estimate on the availability of a donor cornea for a particular date.

Most commonly, the waiting time can be a few months.

PREPARATION

Corneal donor tissue does not need to be specifically matched to your blood type.

As the cornea can only be stored for a certain period of time, it is possible, although relatively unlikely, that your surgery will need to be rescheduled at short notice if donor tissue is not available.

If your surgery is cancelled due to a lack of corneal donor tissue, you will be notified by your surgeon and placed on the Service’s list for the next available cornea. This may result in a wait of a few extra weeks.

Conversely, there may be additional donor corneas available during some weeks, with the number of corneas exceeding the number of scheduled cases. In these weeks, your surgeon may phone you to offer you an earlier surgical date.

It is therefore crucial to have some flexibility when considering corneal surgery. Please make sure that your family, work and friends are all aware that you are having corneal transplant surgery and that you may be called in at short notice.

HOW IS THE CORNEAL TRANSPLANTATION PERFORMED?The surgery may be performed under local or general anaesthetic. Your surgeon or anaesthetist will inform you as to the most appropriate form of anaesthetic for you.

The entire surgery is conducted under an operating microscope. The diseased layer of your cornea will be removed, and replaced by the corresponding layers of the donor cornea.

The procedure will likely take between 30 and 90 minutes, but will be much longer when you take in to account anaesthetic and recovery time. At the conclusion of the procedure, a pad and plastic shield are applied to protect the eye.

Your surgeon will discuss with you any specific requirements such as maintaining certain posture for the first night after surgery.

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HOW LONG DO I HAVE TO WAIT FOR A CORNEAL TRANSPLANT?When you and your surgeon determine that you require a corneal transplant, you will be given a date for surgery.

This date will depend on several factors, such as availability of the surgeon, the anaesthetist and operating theatre, your own wishes and importantly, an estimate on the availability of a donor cornea for a particular date.

Most commonly, the waiting time can be a few months.

SURGERYCorneal donor tissue does not need to be specifically matched to your blood type.

As the cornea can only be stored for a certain period of time, it is possible, although relatively unlikely, that your surgery will need to be rescheduled at short notice if donor tissue is not available.

If your surgery is cancelled due to a lack of corneal donor tissue, you will be notified by your surgeon and placed on the Service’s list for the next available cornea. This may result in a wait of a few extra weeks.

Conversely, there may be additional donor corneas available during some weeks, with the number of corneas exceeding the number of scheduled cases. In these weeks, your surgeon may phone you to offer you an earlier surgical date.

It is therefore crucial to have some flexibility when considering corneal surgery. Please make sure that your family, work and friends are all aware that you are having corneal transplant surgery and that you may be called in at short notice.





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the body’s immune system recognizing the new cornea as foreign tissue and attacking the cells of the donor cornea.

A good way to remember the warning signs of rejection are to remember the letters RSVP:

• R is for Redness

• S is for Sensitivity to light

• V is for Visual loss (blurred vision)

• P is for Pain/discomfort

If you experience any of these signs or flashing lights, floaters

and loss of peripheral vision, contact your surgeon immediately.

Steroid eye drops placed in the eye after surgery can prevent rejection. It is important to continue your eye drop regimen as per your ophthalmologist’s directions. Do not stop taking the drops unless advised by your surgeon. If tissue rejection occurs, it can often be reversed by intensive use of topical steroids and other medications if detected early, so present to your surgeon without delay.

Depending on the type of transplant, sutures may be removed at 4-6 weeks after the surgery, or remain in place for up to 2 years.

Your surgeon will advise you as to the need to avoid certain activities such as driving and physical activity for a certain period of time after the operation.



AFTER SURGERY

WHAT CAN I EXPECT AFTER THE SURGERY?Your surgery may be performed as a day procedure, or you may be required to stay one or two nights in the hospital.

While you may have some disomfort, it is unusual to have severe pain, and you should contact your surgeon if this occurs. The eye will be red and tender. A scratchy sensation may be felt due to stitches on the surface of the eye or the wounds through which the surgery is performed, but this will gradually wear off.

You will be instructed on how to use the necessary medications, which may be ointment, eye drops and/or tablets, and given a treatment schedule to follow. It is important to follow this schedule as directed to reduce the risk of infection and rejection.

Follow up is extremely important after corneal transplantation. This will remain important for the life of your transplant. Early on, appointments are quite frequent, but these do reduce with time.

Rejection of the donor cornea may sometimes occur. This is caused by



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Sutures holding the corneal transplant in place

RECOVERYAND RISKS

















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HOW QUICKLY WILL MY VISION RECOVER?Return of best vision after corneal transplant surgery takes a variable amount of time. Most commonly, the best potential vision is reached by about 2 years, but you may have quite good vision before this time. Your ophthalmologist will advise you as to the most appropriate time to get new glasses or contact lenses.

WHAT ARE THE RISKS OF THE SURGERY?Using modern surgical techniques, the risk of corneal transplant surgery is relatively small, however, as with any operative procedure, complications may occur. Haemorrhage or infections in the eye are potentially serious complications that may cause permanent loss of vision or loss of the eye itself, but these are rare.

Complications arising from anaesthesia may occur. Local anaesthesia occasionally causes haemorrhage around the eye and

rarely results in direct damage to the eye itself. General anaesthesia carries a small, but potentially serious risk. The anaesthetic will be discussed with you in more detail prior to your operation.

Your surgeon will discuss and explain the risks to you. You should also raise any particular concerns with them.

WILL I HAVE TO PAY?The Lions Eye Donation Service charges a fee for provision of a cornea.

The fee is not a charge for the cornea itself. Rather, it covers all costs involved in eye donation including staff salaries, laboratory testing, equipment and maintenance, medical consumables and infrastructure costs.

For patients with Private Health Insurance, the Health Insurer will pay 100% of the fee levied by the service.

For patients under the public health system, the fee is re-couped directly from the State Government Health Department.

Please note that the Service’s fee is not covered by the Medicare Health System.

So if you choose to go privately but without insurance you will be responsible for direct payment of the same fee.

CAN I WRITE TO THE FAMILY OF MY DONOR?The law in Australia prohibits transplant services to identify donors and recipients to each other. Correspondence can be passed via our office between the recipient and donor family provided it does not identify either party.

The Service sends out Correspondence Guidelines to recipients shortly after surgery. This guide details what information you can and cannot give. The decision as to whether to

FEES ANDCORRESPONDENCE13

write to your donor family is a very personal one and is fully respected by the Service. Recipients should feel under no obligation.

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WILL I HAVE TO PAY?The Lions Eye Donation Service charges a fee for provision of a cornea.

The fee is not a charge for the cornea itself. Rather, it covers all costs involved in eye donation including staff salaries, laboratory testing, equipment and maintenance, medical consumables and infrastructure costs.

For patients with Private Health Insurance, the Health Insurer will pay 100% of the fee levied by the service.

For patients under the public health system, the fee is re-couped directly from the State Government Health Department.

Please note that the Service’s fee is not covered by the Medicare Health System.

So if you choose to go privately but without insurance you will be responsible for direct payment of the same fee.

CAN I WRITE TO THE FAMILY OF MY DONOR?The law in Australia prohibits transplant services to identify donors and recipients to each other. Correspondence can be passed via our office between the recipient and donor family provided it does not identify either party.

The Service sends out Correspondence Guidelines to recipients shortly after surgery. This guide details what information you can and cannot give. The decision as to whether to

write to your donor family is a very personal one and is fully respected by the Service. Recipients should feel under no obligation.

Help us to help youIf you have any questions, please do not hesitate to contact:

The Transplant Coordinator:

Lions Eye Donation Service – Melbournec/o Royal Victorian Eye and Ear HospitalPhone: 03 9929 8708Email: [email protected]

Contacts

mailto:[email protected]

Documents

Clearer Skies web3 - Centre for Eye Research Australia · 2014-08-19 · CLEARER SKIES AHEAD Corneal Recipient Information Brochure. Information about your corneal transplant A project