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Question:
I am having a full corneal transplant done next week and wanted to hear positive results from people but all I hear is that it gives you double or quadruple vision. Is this permanent? How soon can I realistically expect the vision in that eye to be correctable to 20/40 so I can drive again? I know everyone is different but stories on the net are not very positive.

Answer:
This is a very difficult question to answer because everyone is different. From your letter, it sounds as if you having a full thickness corneal transplant (there are different forms of transplants for different problems). This is called a penetrating keratoplasty or PKP. PKPs are the most common form of tissue transplantation in the world, and a highly successful one at that. There is roughly a 90 percent rate of graft acceptance — remember that this is tissue transplantation of a donated cornea to your eye. Graft acceptance is an important concept as this is not your body's tissue. Of the 90 percent whose body accepts their transplants immunologically, perhaps one-half to two-thirds can be corrected by glasses.

Remember that the surgeon has little control of the curvature of the front of the new donated cornea and that is the most important optical element in the eye; it's two to three times more powerful than the lens of the eye. That means that your Eye M.D. will have difficulty predicting the power of the cornea after surgery. The cornea may tilt a bit because of the sutures or healing asymmetry too — this is called astigmatism, and can give multiple or smudged images. The patients who have PKPs and cannot be fit with glasses successfully can almost always be fit with contact lenses and achieve good vision. Most, but not all, patients achieve good vision after surgery although they may have to wear contact lenses to do so. Remember that many of those who do achieve good vision may never write anything on a website — they are too busy with their new eyes. But, the reason a PKP is being contemplated for your eye is that you do not see well with it at this time.

You must realize that a PKP is still eye surgery and a form of tissue transplantation from a donor to your eye, and there are potential risks, including that of contact lens wear to eliminate double vision and potential complications. Discuss these issues with your Eye M.D. and you will be able to better understand your chances of achieving good vision.

Answered by: Ivan Schwab, MDDr. Ivan Schwab

Categories: Eye Conditions, Eye Diseases, Cataracts, Eye Surgery

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Answered: Nov 23, 2010

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