Chapter 39 - Corneal transplantation

Summary

Corneal transplantation, or keratoplasty, is the surgical procedure most commonly used in the management of blinding opacification of the normally transparent cornea. When donor eyes are transported to eye banks, cornea is removed for storage at either 4ºC for up to 10 days in chondroitin sulphate-based medium or 34º C in serum-based medium. Anterior lamellar surgery can be sufficient to restore transparency in those corneas with stromal opacity but healthy endothelium; conversely, posterior lamellar replacement may sluice in those with healthy stroma. Both the anterior chamber together with the peripheral recipient corneal bed and allogeneic donor cornea itself enjoy relative immune privilege. Some features of the immunobiology of corneal rejection differ from allogeneic rejection of other transplanted tissues. The key to successful treatment of corneal graft rejection is early recognition of the rejection episode by the patient and clinician.