Barraquer Eye Hospital (Barcelona, Spain) : corneal transplant pioneers

Currently there are several corneal transplant techniques.

• Penetrating corneal transplant (penetrating keratoplasty). It is to change the whole cornea.
• Lamellar Corneal transplantation (lamellar keroplasty). It is to substitute the sick cornea partially.

After a preoperative examination in the facilities of Barraquer Eye Hospital and depending on the condition of the patient’s cornea, the choice of a type of surgery will be made.

Until recently the most used technique was penetrating keratoplasty (PK) in which all layers of the cornea are replaced. During this procedure, the surgeon removes a small round piece of the cornea. A circular area of equal size is cut in the center of the donor cornea, and is placed and sutured in the patient.

Today, and thanks to the latest scientific advances, it is possible to selectively transplant the diseased layer or layers of the cornea. These are lamellar keratoplasty (lamellar corneal transplantation) or endothelial cornea transplantation (DSAEK / DMEK) usually performed at Barraquer Eye Hospital in Barcelona (Spain).

There are different lamellar transplantation techniques depending on whether the superficial, deep anterior corneal layers or the posterior corneal layers are replaced.

By applying this technique the refractive results are much more predictable, with less astigmatism, reducing recovery times and minimizing complications.

Lamellar corneal transplantation is a less aggressive technique than penetrating keratoplasty. In general, the patient has less risk of rejection of the transplanted tissue and less complications. In addition, the postoperative period is usually more comfortable and visual recovery is faster.

Another advantage of lamellar keratoplasty against penetrating keratoplasty is the greater ease of subsequent replacement of the transplanted tissue in case of rejection.

The Barraquer Clinic in Barcelona (Spain) is also using the amniotic membrane as an alternative treatment.

Amniotic membrane transplantation consists of the placement of a fragment of amniotic membrane on the cornea, fixing it with very fine sutures. The technique is painless, does not require hospitalization and is performed under local anesthesia.

The amniotic membrane is a layer of the human placenta that contains natural substances with growth factors that help to regenerate tissues and control inflammation.
This technique is used:

– As a graft to fill a corneal defect.
– As a coating to reduce inflammation of the ocular surface and promote epithelial healing without leaving sequels or opacities.

A corneal transplant is necessary if the vision cannot be corrected satisfactorily with contact lenses, or if painful swelling cannot be relieved with medication or special contact lenses.

It is recommended for people who have:

– Vision problems caused by thinning of the cornea, almost always due to keratoconus. In this case, a transplant can be contemplated when no less invasive treatments are possible (such as Crosslinking or Keraring or SAI rings)

– Scarring of the cornea due to infections (especially due to herpetic keratitis) or serious injury.

– Loss of vision due to Fuchs’ dystrophy (due to hereditary factors).

Corneal transplantation is a very common surgical procedure. Barraquer Eye Hospital in Barcelona (Spain) is equipped with the most advanced technology that minimizes the risks that can occur during surgery. A successful corneal transplant will provide the patient with good vision for many years. Your quality of life at the visual level will improve considerably.

However, you should keep in mind that full recovery of sight can take up to a year. As a risk, there is a possibility that the eye will reject the transplanted tissue. Sometimes, rejection can be controlled with ophthalmic drops with steroids.

Often, after the transplant, the use of glasses or contact lenses is required for better vision.

Other risks associated with corneal transplantation include:
– Bleeding
– Cataracts
– Infection of the eye
– Increased pressure inside the eyeball (glaucoma)
– Corneal inflammation
– Problems with stitches to fix the donor cornea

The cornea to be transplanted normally comes from a donor. Before the cornea is transplanted, virus tests (hepatitis, AIDS and other potentially infectious diseases) should be performed. The donated cornea is analyzed to verify that its use is safe in surgery and that its transparency is adequate. It is always verified that the fabric meets the legal requirements.

Unlike other organs, such as the liver and kidneys, people who need corneal transplants generally do not have to endure long waits.

On the other hand, Spain has been a pioneer in the use of artificial corneas. The first center that grafted the artificial cornea was the Barraquer Institute in 2006. This alternative is used in cases where one or more corneal transplants from donors fail.

Another type of corneal transplant may be the autotransplant of the same patient.

Preparing for surgery

Once the date of the intervention is specified, you must go the previous day to the facilities of the Barraquer Hospital to take a series of preoperative exams.

To prevent bacterial growth around the eyes, makeup should be avoided for a few days.

How is corneal transplant surgery developed?

The surgery is performed in the operating room with the necessary sterility measures.
The intervention lasts between 30 and 40 minutes. Corneal transplantation is usually performed under local anesthesia or, rarely, with general anesthesia depending on the patient’s characteristics. The patient will remain at the Barraquer Hospital for two or three days depending on their evolution. Your stay in Barcelona will be about one month, to be able to perform the proper post-operative controls. It is also necessary to carry out a medical control after 3 or 6 months, depending on the patient’s postoperative course.

In case the two eyes have to be operated on, the surgery will be done separately by performing the surgery of the second eye one year later.

The immediate postoperative period

It is important to follow the following guidelines during the postoperative period:

– Relative rest. You should remain calm at home and refrain from straining, bending, and lifting right after the surgery.

– It is important to sleep on the unopened eye.

– When bathing, do not wet the patch.

Specialists at the Barraquer Clinic will prescribe drops to help the eye heal, as well as prevent infection and rejection. Medications should be given exactly as the doctor tells you to. Most patients do not suffer from pain in the operated eye, although some discomfort may occur. In that case it is usually enough to take a painkiller. If it does not improve or is very intense you should call your doctor or go to the emergency room.

It is normal for the first few days to see blurred and feel itchy due to inflammation and the presence of sutures. This will improve as time passes.

The first few days are very important for the recovery of the transplant.

The first weeks

The doctor will remove the stitches at a control visit. Some of these points can be left in place for up to a year or may not be removed completely.

It is important to wear safety glasses or eye protectors in situations that carry even a slight risk of injury to the eye, such as sports.

The postoperative follow-up lasts several months. A careful control by the professionals is necessary in order to avoid the complications in the long term.

Your vision may initially be worse than before surgery until your eye is adjusted to the new cornea. It may take several months for your vision to improve.

Corneal transplant surgery cost depends on many factors. We would be delighted to answer your query. Please, fill in this form. If you have any medical reports or examination results from other centres, we would appreciate it if you could send these tests to us by email so we can offer you the solution that best suits your needs.

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Qualified personnel are placed at your disposal and they will advise you in your language and accompany you during all the hospital process. In case the doctor does not speak your language, a personal interpreter can accompany you throughout all your visits.

All surgery carries a certain level of risk. For this reason, it is important to carry out a preoperative consultation in Barraquer Hospital, since it allows the ophthalmologist to avoid unnecessary risks.

Visual recovery can be very slow and medication should be taken over a period of 6 to 12 months. Removal of the sutures, in most cases, will improve vision. This will be done based on the age, healing and other factors of the patient.

The transplanted cornea is an organ outside the body and the body can recognize it as something “strange” at any time, and attack it as a defense of the body.

This can happen immediately after surgery, in months, or even after years. Rejection occurs in about 20% of corneal transplants.

Medications that stop rejection can sometimes be given. Ask for an appointment with your ophthalmologist if you notice any signs and symptoms of rejection, such as:

• Decreased vision
• Pain
• Red eye
• Sensitivity to light
• Tearing

Corneal transplantation (keratoplasty) is usually performed under local anesthesia or, rarely, with general anesthesia and it is usual for the duration of the intervention to be less than one hour. The patient will remain admitted to the Barraquer Hospital for two to three days depending on their evolution.

No, if both eyes have to be operated, surgery will be done separately. The time between the two surgeries will depend on how the patient progresses after the first transplant. It will usually take a few months before the second corneal transplant is done.

Yes, once the patient’s cornea is removed, the cataract is removed and if possible an intraocular lens is placed in the lens capsule.