The cornea degenerative diseases are usually hereditary, bilateral, the location and the shape of subsidence are usually specific. The symptoms develop when the patient is 10-20 years old, the disease progresses slowly, it may recur on family members, but with a corneal transplantation the problem can be solved.
Several forms may be distinguished according to the location: superficial, in the middle, in the range of the third back half and mixed. The superficial degeneration which goes together with harness deficiency can be treated well with an excimer laser therapeutic procedure. In other cases superficial cornea degeneration with irregular edges, whitish cornea discoloration may occur, which may be treated with surgical excision of excimer laser procedure.
In cases when a patient has disease conditions such as bulging outward of the cornea (keratoconus), a malfunction of the inner layer of the cornea (Fuchs' dystrophy), and painful swelling of the cornea (pseudophakic bullous keratopathy), corneal transplantation needs to take place. It is advisable to have this surgery done as soon as possible, in the earliest stage, when the outer cornea areas did not become very thin yet. Thus there are fewer problems with the rejection of the implanted disc, it is also easier to insert, and it ensures better eyesight rehabilitation. There are no blood vessels in the cornea, thus a transplantation is favorable from an immunological point of view, only with a minimal frequency it is rejected by the body, since the cornea does not have it’s own blood supply. It gains the different necessary nutrients and oxygen from the adjacent tissues and liquids.
Thus the cells and the antibodies do not reach the freshly implanted cornea, they do not meet with extraneous tissue, thus is the reason why a rejection reaction does not take place. Nowadays the corneal transplantation is a routine procedure, the donor corneas are provided from the so-called cornea banks, where preliminary HIV and hepatitis screening tests are done, thus the chance of infections is reduced to a minimum. Before the transplantation a thorough examination needs to take place, it is important for the surgeon to be aware of the sings indicating squinting, ambylopia, glaucoma as well as problems of the visual nerves and the retina, because these may influence the success of the transplantation and the expected visual acuity.
Two main types of corneal transplantation are known. One of them is pervasive cornea transplant, the whole cornea is transplanted in this case. In cases when pervasive cornea transplantation is required, then here belong all the circular processes affecting all of the layers of the cornea. This type of corneal transplantation is the one which is often applied in Hungary. During the layer corneal transplantation certain layers of the cornea are transplanted into the place of the patient’s cornea layers. Here belongs the transplantation of the superficial as well as deeper layers. Both interventions affect the centre of the cornea in the form of a disk with a diameter of 6-9 millimeters.
During this microscopic surgical treatment, the duration of which is about an hour, local or general anesthesia is used. After the surgery the patient usually spends one or two nights in the hospital, but may also go home on the day of the surgery.