Penetrating Keratoplasty (PK or PKP) Cornea Transplant Instructions
PK SURGERY OVERVIEW
When the cornea becomes swollen, cloudy, scarred from infection or trauma, perforated, or warped it may need to be replaced surgically. PK surgery involves replacing all of the layers of the cornea with a full thickness graft of human donor tissue to restore corneal clarity. As the cornea tissue comes from human donors, it is a true gift of sight. The donor process is similar to that used for other donor organs. Serology is done on every donor and all donors are screened to exclude HIV and Hepatitis viruses. The donor cornea is screened carefully prior to deeming it suitable for surgical use by the eye bank and only those passing the strict parameters set by the Eye Bank Association of America are accepted for transplant.
In PK surgery, your eye surgeon removes a full thickness, circular central portion the cornea and replaces it with a full thickness donor cornea graft. The graft is sutured into position using Nylon sutures (non-dissolving). The healing process for PK takes a long time and it can be over a year before vision may improve. The goal of a PK corneal transplant is to stabilize the eye and to improve the decreased vision that was caused by the diseased cornea. A cornea transplant will not correct decreased vision caused by other eye conditions such as a cataract or glaucoma.
PREPARING FOR PK SURGERY
BEFORE PK SURGERY:
PK surgery is often performed under general anesthesia which may require clearance from your primary care doctor or anesthesia. If you have a history of Cardiac (Heart), Pulmonary (Lung), or other serious health condition you may need to obtain Primary Care or Cardiology Clearance prior to surgery. This clearance may need to be faxed or sent to your surgery center in advance.
Prior to surgery, it is important to review all your medications with your doctor and you may be asked to adjust some medications before surgery. If you take a blood thinner, please talk to your prescribing doctor about the risks and benefits of holding it before surgery. If you are not sure if you take a blood thinner or would like more information, please talk to your primary care provider. Additional information on blood thinners around the time of surgery is provided on the home page for eye surgery instructions. You may be asked to start eye drops prior to your surgery to help reduce swelling and inflammation and risk of infection after surgery.
THE DAY OF PK SURGERY
THE DAY OF SURGERY:
Your surgery will be done in an outpatient surgery center or hospital and you will likely go home the same day. Continue all your usual eye drops as prescribed, including the morning of surgery. You may take your usual blood pressure or heart medications with a small sip of water in the morning unless directed otherwise by your doctor or anesthesia team.
One business day prior to your surgery someone will call you from the surgery center to discuss your arrival time for surgery. Plan to be at the surgery center for 4-6 hours.
Surgery requires FASTING. NO EATING OR DRINKING starting at MIDNIGHT the night before surgery. If your surgery is scheduled for the afternoon, then please NO EATING OR DRINKING AT LEAST 6 HOURS BEFORE your arrival time.
Please wear loose comfortable clothing. Shower and wash your hair the evening prior or morning of your surgery. WASH YOUR FACE THOROUGHLY.
No Makeup, Perfume, Lotions, or Jewelry/Valuables. No Smoking or Alcohol 24 hours prior to surgery.
You will need to arrange transportation to and from the surgery. You may NOT drive yourself.
ANESTHESIA FOR PK CORNEA SURGERY
ANESTHESIA FOR PK CORNEA SURGERY
Many patients worry if cornea transplant surgery will be painful. Modern anesthesia has advanced greatly, helping patients feel comfortable during the procedure. PK surgery is often performed under full general anesthesia though some patients prefer to undergo the surgery with local anesthesia or an eye block. Topical numbing drops are often used as well.
General Endo-Tracheal Anesthesia
Full general anesthesia is where the patient is fully sedated under anesthesia with a breathing tube during surgery. Most patients prefer to have general anesthesia during PK surgery for maximum comfort during the procedure.
Local Anesthesia:
Local anesthesia involves numbing the eye with an injection around the eye. Often sedation is given during the block injection so that you remain comfortable and relaxed. This is called a peribulbar or retrobulbar block and it can help place the eye in a deeper state of numbing.
Intravenous (IV) Anesthesia:
If you choose to have PK surgery with a local eye block, you will likely be offered IV sedation as well. Sedating medications, such as Versed and Fentanyl, are given to help relax you during your surgery. All medications are dosed incrementally to achieve the right level of sedation and comfort for each patient. Please be aware that even with IV sedation, you will likely be awake. If you elect IV sedation, do not expect to be “put to sleep” as your eye surgeon often prefers that you can hold still and focus on the microscope light during the procedure.
PK CORNEA SURGERY POST-OPERATIVE RECOVERY
CORNEA SURGERY RECOVERY
PK surgery is transplant surgery. Topical steroid eye drops are required to reduce the risk of graft rejection. In most cases, steroid drops are continued forever however the dose gradually is reduced over the course of a year to once or twice daily. Stopping the steroid drop is associated with a significantly increased risk of graft rejection and failure. NEVER stop using your steroid eyedrop unless specifically directed to stop by your cornea transplant surgeon.
It is normal for your eye to be very red and to feel scratchy and sore after surgery. The eye will be patched immediately after surgery and we will take the patch down the following day in clinic. You may use lubricating drops and eye ointments to help. It normal to have very limited vision initially after surgery.
No bending or lifting anything over 20 lbs.
Pick up your medication eye drops PRIOR to surgery as you may be asked to start them right away after surgery. Your doctor will review your post op medications with you so please bring them with you to your follow up appointment.
If you notice nausea/vomiting, fevers, decreased vision, pain, flashes of light, hundreds of new floaters, or a curtain or veil over your vision, please call the office at 941-499-1570 right away.
RESUMING ACTIVITIES AFTER PK CORNEA SURGERY
RESUMING ACTIVITIES AFTER SURGERY
You may resume your normal diet and medications immediately after surgery.
No bending or heavy lifting more than 20lbs until cleared by your eye surgeon.
Wait to drive until advised by your doctor. Sleep in the eye shield at night for 1 month. It is never a good idea to rub your eye, but especially avoid rubbing your eye after surgery. You may shower after surgery but face away from the water and avoid getting water directly in your eye for a few days.
NO SWIMMING POOLS, HOT TUBS, or GARDENING (LAWN MOWING) until cleared by your surgeon. These activities increase your risk of serious eye infection during the post op period. Wait 4-6 weeks to play woodwind and brass instruments. Wait 6 months to scuba dive after PK eye surgery.
You may wear your regular eye glasses after surgery however the old prescription will no longer work in the surgical eye. Some people opt to replace the lens in front of the eye that had surgery with a clear glass with no power in it. Glasses or specialty contact lenses may be prescribed after surgery, though typically you will need to wait over a year for the eye to heal.
VISION RECOVERY AFTER PK CORNEA SURGERY
Vision recovery after cornea transplant surgery can take 1-2 years. Many times there can be high astigmatism in the cornea graft or the astigmatism can be irregular. Regular astigmatism is often correctable with glasses, though high amounts may need a contact lens. If the astigmatism is irregular then the light passing through the cornea is bent like it is passing through a “fun house” mirror and glasses do not correct that type of astigmatism well. Specialty contact lenses may need to be fitted if you have irregular astigmatism after healing from PK surgery.
Roughly a year after healing from the initial transplant surgery, your eye surgeon may discuss removing some or all of the sutures that were holding the graft in place. These adjustments are made to either reduce your risk of rejection and infection or to try to improve the vision by changing the suture tension on the graft.