Placement for Corneal Transplantation
Only a thorough examination by an ophthalmologist can determine if an individual could benefit from or is ready for a corneal transplant. When an ophthalmologist determines that a patient requires a corneal transplant, the patient’s name is listed on the Lions Eye Donation Service’s surgery schedule. The date of the surgery will be determined by available surgeon, anaesthetist and operating theatre time, the patient’s own wishes, and importantly, an estimate by the Lions Eye Donation Service on the availability of a donor cornea for a particular date.
Patients electing to have their transplant performed privately should discuss all costs with their chosen ophthalmologists – these will include surgeon fee, anaesthetist fee, hospital bed, operating theatre and other charges. It should also include Lions Eye Donation Service fees.
While it is illegal to buy or sell human eyes, organs and tissues, Lions Eye Donation Services are allowed to recover their costs involved in the eye donation. They do this through the charging of a service fee for the provision of the cornea. Expenses to the Lions Eye Donation Service include staff salaries, laboratory testing, equipment and maintenance, medical consumables, office supplies, utilities and infrastructure costs. If the patient has private health insurance, the health insurer will pay 100% of the service fee levied by the Lions Eye Donation Service – Melbourne. If the patient elects to go privately but without medical insurance they will be liable to pay the Eye Donation Services fee – it is not covered by the Medicare national health system.
If you elect to have your transplant performed under the public health system in a public hospital, the Lions Eye Donation Service will recover their costs directly from the State Government Health Department.
Preparing for Surgery
Prior to surgery the patient is required to complete laboratory tests which may include blood and urine tests, ultra-sounds, x-rays, electrocardiograms and further eye tests.
The surgeon’s rooms will inform the patient of the operative details including pre-admission fasting requirements, what to bring along, any pre-admission medication requirements and the possibility of overnight admission (though corneal surgery is routinely completed in a day surgery setting within Australia). Additionally they will ensure that an informed consent process for surgery has been completed with the patient.
The hospital or day surgery nursing team will also conduct their own pre-operative phone call assessment with the patient or next of kin in order to ensure the surgery team are prepared for the day.
Every patient is different and their surgical requirements and tissue requirements are different, therefore it is advised the patient contacts the surgeon or hospital/day surgery where the surgery will take place.
Variations include the tissue removal and replacement type (and cutting devices), additional eye issues that could require surgery, anaesthetic variations and expected outcomes.
Immediately after surgery, patients are cared for in recovery until they meet safe discharge criteria. Upon discharge, each hospital/day surgery will provide post-operative instructions that include information on; what to expect, physical restrictions that could affect the graft (e.g. heavy lifting or bending forward), pain relief or other medication requirements, emergency contact details and a follow-up appointment time.
As a general rule, most corneal patients will go home with an eye-patch over the operative eye and are required to return for a follow-up review the next day.
The early recovery period will vary between one to three weeks following surgery. During this time the patient is advised to follow the surgeon’s post-operative instructions and attend follow-up appointments.
Resuming daily activities, such as driving, need to be discussed with the surgeon to ensure a safe and appropriate recovery is completed.
If the patient’s body begins to reject the transplant or if any other problems occur, the situation can often be remedied if the patient contacts an ophthalmologist immediately. If a transplant does fail another corneal transplant can be performed. In particular, transplant recipients must watch for the following:
Redness of the eye
For the first few weeks after surgery, the eye will be red and become less so as time goes by. However, if there is any substantial increase in redness or redness after the recovery period please contact an ophthalmologist.
Some light sensitivity after surgery is expected and it should gradually decrease. If the eye becomes more sensitive to light than usual then contact an ophthalmologist.
Patients are advised to select an object at home to test their vision on every day. Changes in vision are expected, but if the check appears more cloudy or blurred than previously then contact an ophthalmologist.
Small twinges of pain during the healing process are expected. However inform the ophthalmologist if the eye hurts or throbs steadily for more than two or three hours.