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Corneal transplantation

Cornea transplant after one year of healing, two stitches are vis-

ible

Cornea transplant one day after surgery.

Corneal transplantation, also known ascorneal graft-

ing, is asurgical procedurewhere a damaged or diseased

corneais replaced by donated corneal tissue (the graft) in

its entirety (penetrating keratoplasty) or in part (lamel-

lar keratoplasty). (Keratoplasty is surgery to the cornea.)

The graft is taken from a recently deceased individual

with no known diseases or other factors that may affect

the viability of the donated tissue or the health of the re-

cipient.

The cornea is the transparentfront part of the eyethat

covers theiris, pupilandanterior chamber. The surgi-

cal procedure is performed by ophthalmologists, physi-

cians who specialize in eyes, and is often done on anoutpatient basis. Donors can be of any age, as is shown

in the case of Janis Babson, who donated her eyes at

age 10. The corneal transplantation is performed when

medicines, keratoconusconservative surgery and cross-

linking can not heal thecorneaanymore.

1 Indications

Indications for corneal transplantation include the follow-

ing:

Optical: To improve visual acuity by replacing the

opaque or distorted host tissue by clear healthy

donor tissue. The most common indication in

this category is pseudophakic bullous keratopa-

thy, followed bykeratoconus,corneal degeneration,

keratoglobusanddystrophy, as well as scarring due

tokeratitisandtrauma.

Tectonic/reconstructive: To preserve corneal

anatomy and integrity in patients with stromalthinning anddescemetoceles, or to reconstruct the

anatomy of the eye, e.g. aftercorneal perforation.

Therapeutic: To remove inflamed corneal tissue un-

responsive to treatment byantibioticsor anti-virals.

Cosmetic: To improve the appearance of patients

with corneal scars that have given a whitish or

opaque hue to the cornea.

1
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2 3 PROCEDURE

2 Pre-operative examination

In most instances, thepatientwill meet with their oph-

thalmologist for an examination in the weeks or months

preceding the surgery. During the exam, the ophthalmol-

ogist will examine the eye and diagnose the condition.

The doctor will then discuss the condition with the pa-

tient, including the different treatment options available.

The doctor will also discuss the risks and benefits of the

various options. If the patient elects to proceed with the

surgery, the doctor will have the patient sign aninformed

consent form. The doctor might also perform a physi-

cal examination and order lab tests, such as blood work,

X-rays, or anEKG.

The surgery date and time will also be set, and the patient

will be told where the surgery will take place. Within the

United States, the supply of corneas is sufficient to meet

the demand for surgery and research purposes. There-

fore, unlike other tissues for transplantation, delays and

shortages are not an issue.[1]

3 Procedure

On the day of thesurgery, the patient arrives to either a

hospitalor an outpatient surgery center, where the pro-cedure will be performed. The patient is given a brief

physical examination by the surgical team and is taken to

theoperating room. In the OR, the patient lies down on

an operating table and is either givengeneral anesthesia,

orlocal anesthesiaand asedative.

With anesthesia induced, the surgical team prepares the

eye to be operated on and drapes the face around the eye.

An eyelidspeculumis placed to keep the lids open, and

some lubrication is placed on the eye to prevent drying.

In children, a metal ring is stitched to the sclerawhich

will provide support of the sclera during the procedure.

3.1 Penetrating keratoplasty

A trephine (a circular cutting device) is used by the sur-

geon to cut the donor cornea, which removes a circular

disc of cornea. A second trephine is then used to remove

a similar sized portion of the patients cornea. The donor

tissue is then sewn in place with sutures.

Antibiotic eyedropsplaced, the eye is patched, and the

patient is taken to a recovery area while the effects of

the anesthesia wear off. The patient typically goes home

following this and sees the doctor the following day forthe first post operative appointment.

3.2 Lamellar keratoplasty

Encompasses several techniques which selectively re-

place diseased layers of the cornea while leaving healthy

layers in place. Advantage includes improved tectonic

integrity of the eye. Disadvantages include the techni-

cally challenging nature of these procedures which re-

place portions of a structure only 500 mthick, and re-

duced optical performance of the donor/recipient inter-

face compared to full thickness keratoplasty.

3.2.1 Deep Anterior Lamellar Keratoplasty

In this procedure, the anterior layers of the central cornea

are removed and replaced with donor tissue. Endothelial

cells and Descemets membrane are left in place. This

technique is used in cases of anterior corneal opacifica-

tions, scars, and ectatic diseases such as keratoconus.

3.2.2 Endothelial Keratoplasty

Replaces the patients endothelium with a transplanted

disc of posterior stroma/Descemets/endothelium

(DSEK) or Descemets/endothelium (DMEK).

This relatively new procedure has revolutionized treat-

ment of disorders of the innermost layer of the cornea

(endothelium). Unlike a full thickness corneal trans-

plant, the surgery can be performed with one or no su-

tures. Patients may recover functional vision in days

to weeks, as opposed to up to a year with full thick-

ness transplants.However, an Australian study has shown

that despite its benefits, the loss of endothelial cells that

maintain transparency is much higher in DSEK com-pared to a full thickness corneal transplant.The reason

may be greater tissue manipulation during surgery, the

study concluded.[2]

During surgery the patients corneal endothelium is re-

moved and replaced with donor tissue. With DSEK, the

donor includes a thin layer of stroma, as well as endothe-

lium, and is commonly 100150 m thick. With DMEK

only the endothelium is transplanted. In the immediate

post operative period the donor tissue is held in posi-

tion with an air bubble placed inside the eye (the anterior
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3

chamber). The tissue self adheres in a short period and

the air is adsorbed into the surrounding tissues.Complications include displacement of the donor tissue

requiring repositioning ('refloating'). This is more com-

mon with DMEK than DSEK. Folds in the donor tissue

may reduce the quality of vision requiring repair. Rejec-

tion of the donor tissue may require repeating the proce-

dure. Gradual reduction in endothelial cell density over

time can lead to loss of clarity and require repeating the

procedure.

Patients with endothelial transplants frequently achieve

best corrected vision in the 20/30 to 20/40 range, al-

though some reach 20/20. Optical irregularity at the

graft/host interface may limit vision below 20/20.

4 Risks

The risks are similar to other intraocular procedures, de-

tachment or displacement of lamellar transplants.

There is also a risk of infection. Since the cornea has

no blood vessels (it takes its nutrients from the aqueous

humor) it heals much more slowly than a cut on the skin.

While thewoundis healing, it is possible that it mightbecome infected by various microorganisms. This risk

is minimized by antibioticprophylaxis(using antibiotic

eyedrops, even when no infection exists).

There is a risk of cornea rejection, which occurs in about

20% of cases.[3]

5 Prognosis

The prognosis for visual restoration and maintenance ofocular health with corneal transplants is generally very

good. Risks for failure or guarded prognoses are mul-

tifactorial. The type of transplant, the disease state re-

quiring the procedure, the health of the other parts of the

recipient eye and even the health of the donor tissue may

all confer a more or less favorable prognosis.

The majority of corneal transplants result in significant

improvement in visual function for many years or a life-

time. In cases of rejection or transplant failure, the

surgery generally can be repeated.

6 History

Eduard Zirm

The first cornea transplant was performed in 1905 by

Eduard Zirm (Olomouc Eye Clinic, now Czech Re-

public), making it one of the first types of transplant

surgery successfully performed. Another pioneer of the

operation was Ramon Castroviejo. Russian eye sur-

geonVladimir Filatov's attempts at transplanting cornea

started with the first try in 1912 and were continued,

gradually improving until on 6 May 1931 he successfullygrafted a patient using corneal tissue from a deceased

person.[4] He widely reported of another transplant in

1936, disclosing his technique in full detail.[5] In 1936,

Castroviejo did a first transplantation in an advanced case

ofkeratoconus, achieving significant improvement in pa-

tients vision.[6][7]

Advances in operatingmicroscopesenabled surgeons to

have a more magnified view of the surgical field, while

advances in materials science enabled them to usesutures

finer than a human hair.
https://en.wikipedia.org/wiki/Sutureshttps://en.wikipedia.org/wiki/Materials_sciencehttps://en.wikipedia.org/wiki/Microscopeshttps://en.wikipedia.org/wiki/Keratoconushttps://en.wikipedia.org/wiki/Vladimir_Filatovhttps://en.wikipedia.org/wiki/Ramon_Castroviejohttps://en.wikipedia.org/wiki/Czech_Republichttps://en.wikipedia.org/wiki/Czech_Republichttp://localhost/var/www/apps/conversion/tmp/scratch_7/%EE%BF%80https://en.wikipedia.org/wiki/Eduard_Zirmhttps://en.wikipedia.org/wiki/Prophylaxishttps://en.wikipedia.org/wiki/Microorganismshttps://en.wikipedia.org/wiki/Woundhttps://en.wikipedia.org/wiki/Aqueous_humorhttps://en.wikipedia.org/wiki/Aqueous_humorhttps://en.wikipedia.org/wiki/Infection


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4 8 ALTERNATIVES

Spanish-born eye surgeon Ramon Castroviejo successfully per-

formed keratoplasty as early as 1936.

Instrumental in the success of cornea transplants were

the establishment ofeye banks. These are organizations

located throughout the world to coordinate the distribu-

tion of donated corneas to surgeons, as well as providing

eyes for research. Some eye banks also distribute other

anatomical gifts.

7 Synthetic corneas

Main article:Keratoprosthesis

7.1 Boston keratoprosthesis

TheBoston keratoprosthesisis the most widely used syn-

thetic cornea to date with over 900 procedures performed

worldwide in 2008. The Boston KPro was developed at

the Massachusetts Eye and Ear Infirmary under the lead-

ership of Claes Dohlman, MD, PhD.

[8]

7.2 AlphaCor

In cases where there have been several graft failures or the

risk for keratoplasty is high, synthetic corneas can substi-

tute successfully for donor corneas. Such a device con-

tains a peripheral skirt and a transparent central region.

These two parts are connected on a molecular level by

aninterpenetrating polymer network, made frompoly-

2-hydroxyethyl methacrylate(pHEMA). AlphaCor is a

U.S.FDA-approved type of synthetic cornea measuring7.0 mm in diameter and 0.5 mm in thickness. The main

advantages of synthetic corneas are that they are biocom-

patible, and the network between the parts and the device

prevents complications that could arise at their interface.

The probability of retention in one large study was esti-

mated at 62% at 2 years follow-up.[9]

7.3 Osteo-Odonto-Keratoprosthesis

Main article: Osteo-Odonto-Keratoprosthesis

In a very rare and complex multi-step surgical procedure,

employed to help the most disabled patients, a lamina of

the patients tooth is grafted into the eye, with an artificial

lens installed in the transplanted piece.

8 Alternatives

8.1 Phototherapeutic keratectomy (PTK)

Main article:Phototherapeutic keratectomy

Diseases that only affect the surface of the cornea can be

treated with an operation called phototherapeutic kerate-

ctomy. With the precision of an excimer laser and a mod-

ulating agent coating the eye, irregularities on the surface

can be removed. However, in most of the cases where

corneal transplantation is recommended, PTK would not

be effective.
https://en.wikipedia.org/wiki/Phototherapeutic_keratectomyhttps://en.wikipedia.org/wiki/Osteo-Odonto-Keratoprosthesishttps://en.wikipedia.org/wiki/Food_and_Drug_Administrationhttps://en.wikipedia.org/wiki/Polyhydroxyethylmethacrylatehttps://en.wikipedia.org/wiki/Polyhydroxyethylmethacrylatehttps://en.wikipedia.org/wiki/Interpenetrating_polymer_networkhttps://en.wikipedia.org/wiki/Boston_keratoprosthesishttps://en.wikipedia.org/wiki/Keratoprosthesishttps://en.wikipedia.org/wiki/Organ_donationhttps://en.wikipedia.org/wiki/Eye_bankhttps://en.wikipedia.org/wiki/Ramon_Castroviejo


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8.2 Intrastromal corneal ring segments

Main article: Intrastromal corneal ring segments

The implants manufactured under the trade name Intacs

are the only patented intrastromal corneal implant that

has US FDA approval and European CE Mark for both

Myopia and Keratoconus. There are over one-hundred

clinical articles at for clinical reference (search for In-

tacs and they all are arranged in chronological order) and

are a well documented clinical solution for treating ker-

atoconus. Another version of intrastromal cornea ring

segments is manufactured under the trade name KeraR-

ing and is available in South America and Europe.With this procedure, the implants are placed in the

stroma to reshape the cornea into a more natural shape.

In mild myopia, this corrects a patients vision. In kerato-

conus, the goal is to reshape the cornea to where contact

lens intolerant patients are able to achieve functional vi-

sion with contact lenses or glasses. Although, surgical

procedure don't carry a guarantee, one clinically proven

benefit of Intacs is that they can be safely removed and

the cornea returns to its pre-operative state. Future treat-

ment options are not affected.

8.3 Contact lenses

Main article: Contact lens

In the early stages and up to the more advanced stages

of keratoconus, contact lenses are often used to improve

vision. Contact lenses improve visual acuity for the ma-

jority of keratoconus patients. The majority of patients

need to use hard contact lenses. Only10 to 20% will need

cornea transplants during their lifetime due to progression

of the disease.

8.4 Corneal collagen cross-linking

Main article: Corneal collagen cross-linking

This procedure aims at stabilizing and strengthening the

cornea by activating a riboflavin solution throughout 30

minutes with UV-A light.

9 New technology

9.1 High speed lasers

Blades are being replaced by high speed lasers in order

to make surgical incisions more precise. These improved

incisions allow the cornea to heal more quickly and the

sutures to be removed sooner. The cornea heals more

strongly than with standard blade operations. Not only

does this dramatically improve visual recovery and heal-

ing, it also allows the possibility for improvement in vi-

sual outcomes.

Since 2004, Amnitrans Eyebank in Rotterdam, The

Netherlands, provides donor corneas pre-cut for ad-vanced keratoplasty procedures, such as DSEK, DSAEK,

FS-DSEK and DMEK. In 2007, Seattle-basedSightLife,

one of the leading corneal tissue banks in the world, in-

troduced a process for the preparation of donated corneal

tissue using a Femtosecond Laser. This process is known

asCustom Corneal Tissue.

9.2 DSEK/DSAEK/DMEK

Endothelial keratoplasty (EK) has been introduced by

Melles et al. in 1998. Today there are three forms of

EK. Deep Lamellar Endothelial Keratoplasty (DLEK)

in which the posterior part of the recipient cornea is

replaced by donor tissue. Descemets Stripping (Au-

tomated) Endothelial Keratoplasty (DSEK/DSAEK) in

which the diseased Descemets membrane is removed

and replaced by a healthy donor posterior transplant. The

transplant tissue can be prepared by a surgeons hand or

ordered already prepared for surgery. Ocular Systems

Inc. was the first organization to deliver prepared grafts

for surgery in 2005.[10] DSEK/DSAEK uses only a small

incision that is either self-sealing or may be closed with

a few sutures. The small incision offers several bene-

fits over traditional methods of corneal transplant suchas Penetrating Keratoplasty. Because the procedure is

less invasive, DSAEK leaves the eye much stronger and

less prone to injury than full-thickness transplants. New

medical devices such as the EndoSaver (patent pending)

are designed to ease process of inserting endothelial tis-

sue into the cornea.[11] Additionally, DSAEK has a more

rapid rate of visual recovery. Vision is typically restored

in one to six months rather than one to two years.

Descemet Membrane Endothelial Keratoplasty (DMEK)

is the most recent EK technique in which an isolated De-
http://www.ocularsystemsinc.com/http://www.ocularsystemsinc.com/https://en.wikipedia.org/wiki/Descemet%27s_membranehttp://www.sightlife.org/cct_what_is.cfmhttp://www.sightlife.org/http://www.amnitrans.nl/content.php?na=25https://en.wikipedia.org/wiki/Corneal_collagen_cross-linkinghttps://en.wikipedia.org/wiki/Contact_lenshttps://en.wikipedia.org/wiki/Intrastromal_corneal_ring_segments


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6 9 NEW TECHNOLOGY

scemet membrane is transplanted. The DMEK proce-

dure is a 'like for like' replacement of the diseased partof the cornea with visual rehabilitation to 20/40 or bet-

ter in 90% of cases and 20/25 or better in 60% of cases

within the first three months. Rejection rates are lower

(1%) and visual recovery is faster than any other form

of corneal transplantation. In the UK (2013) DMEK is

available to patients under the National Health Service at

the Royal Shrewsbury Hospital[12] and the Calderdale and

Huddersfield NHS Trust.[13]

Not all patients with diseased corneas are candidates

for endothelial keratoplasty. These procedures correct

corneal endothelial failure, but are not able to correct

corneal scarring, thinning, or surface irregularity. Thereis currently limited data on long-term survival of DMEK

grafts however the early indications are very positive.

9.3 Stem cells

There is a bioengineeringtechnique that uses stem cells

to create corneas or part of corneas that can be trans-

planted into the eyes. Corneal stem cells are removed

from a healthy cornea. They are collected and, through

laboratory procedures, made into five to ten layers of

cells that can be stitched into a patients eye. The stem

cells are placed into the area where the damaged corneatissue has been removed. This is a good alternative

for those that cannot gain vision through regular cornea

transplants. A new development, announced by the Uni-

versity of Cincinnati Medical School in May 2007, would

use bone marrow stem cells to regrow the cornea and its

cells. This technique, which proved successful in mouse

trials, would be of use to those suffering from inherited

genetic degenerative conditions of the cornea, especially

if other means like a transplant aren't feasible. It works

better than a transplant because these stem cells keep

their ability to differentiate and replicate, and so keep the

disease from recurring, longer and better.

9.3.1 Limbal stem cells

In a further development, in a Wednesday, July 2,

2014 news release from Harvard University's web page

(from the online edition of the Harvard Gazette uni-

versity newspaper, authored by Massachusetts Eye and

Ear Communications), it was stated that,: Researchers

have identified a way to enhance regrowth of human

corneal tissue to restore vision, using a molecule that acts

as a marker for hard-to-findlimbal stem cells extquot-

edbl. A photograph next to the article states that hu-man donor corneal tissue contained the stem cells and

that they led to fully functional mouse corneas. The sec-

ond paragraph goes on to state,: This work, a collabora-

tion among the Harvard-affiliatedMassachusetts Eye and

Ear/Schepens Eye Research Institute,Boston Childrens

Hospital, Brigham and Womens Hospital, and the VA

Boston Healthcare System, holds promise for burnpa-

tients, victims ofchemical injury, and others with dam-

aging eye diseases. The research, published this week in

the journalNature, is also one of the first examples of

constructing a tissue from an adult-derivedhuman stem

cell. Antibodies were used to find the molecule used as

a marker, namedABCB5. The article goes on to statethat the co-senior authors of the study are Bruce Ksander

of Mass. Eye and Ear and postdoctoralfellow Paraskevi

Kolovou extquotedbl. Lastly, it is important to note, as

Ksander and others go on to state, that it was an exam-

ple of basic research able to be moved relatively quickly

to translational applications (by definition, one that can

be used relatively quickly by the pharmaceutical industry

once the methods have been verified and receive govern-

mental regulatory approval). This had to be supported by

a number of collaborators, listed at the end of the article,

including several universities and multiple other agen-

cies, such as the VA Department, the National CancerInstitute, and the NIH (theNational Institutes of Health,

specifically itsNational Institute of Neurological Disor-

ders and Stroke) in order to hope to be carried out.[14]

9.4 Biosynthetic corneas

On 25 August 2010 investigators from Canada and Swe-

den reported results from the first 10 people in the world

treated with the biosynthetic corneas. Two years after

having the corneas implanted, six of the 10 patients had

improved vision. Nine of the 10 experienced cell and

nerve regeneration, meaning that corneal cells and nerves

grew into the implant. To make the material, the re-

searchers placed a human gene that regulates the nat-

ural production of collagen into specially programmed

yeast cells. They then molded the resulting material into

the shape of a cornea. This research shows the potential

for these bioengineered corneas but the outcomes in this

study were not nearly as good as those achieved with hu-

man donor corneas. This may become an excellent tech-

nique, but right now it is still in the prototype stage and

not ready for clinical use. The results were published in
https://en.wikipedia.org/wiki/National_Institute_of_Neurological_Disorders_and_Strokehttps://en.wikipedia.org/wiki/National_Institute_of_Neurological_Disorders_and_Strokehttps://en.wikipedia.org/wiki/National_Institutes_of_Healthhttps://en.wikipedia.org/wiki/National_Cancer_Institutehttps://en.wikipedia.org/wiki/National_Cancer_Institutehttps://en.wikipedia.org/wiki/Paraskevi_Kolovouhttps://en.wikipedia.org/wiki/Paraskevi_Kolovouhttps://en.wikipedia.org/wiki/Fellowhttps://en.wikipedia.org/wiki/Bruce_Ksanderhttps://en.wikipedia.org/wiki/ABCB5https://en.wikipedia.org/wiki/Human_stem_cellhttps://en.wikipedia.org/wiki/Human_stem_cellhttps://en.wikipedia.org/wiki/Naturehttps://en.wikipedia.org/wiki/Chemical_injuryhttps://en.wikipedia.org/wiki/Burnhttps://en.wikipedia.org/wiki/VA_Boston_Healthcare_Systemhttps://en.wikipedia.org/wiki/VA_Boston_Healthcare_Systemhttps://en.wikipedia.org/wiki/Brigham_and_Women%27s_Hospitalhttps://en.wikipedia.org/wiki/Boston_Children%27s_Hospitalhttps://en.wikipedia.org/wiki/Boston_Children%27s_Hospitalhttps://en.wikipedia.org/wiki/Massachusetts_Eye_and_Ear/Schepens_Eye_Research_Institutehttps://en.wikipedia.org/wiki/Massachusetts_Eye_and_Ear/Schepens_Eye_Research_Institutehttps://en.wikipedia.org/wiki/Limbal_stem_cellshttps://en.wikipedia.org/wiki/Harvard_Gazettehttps://en.wikipedia.org/wiki/Harvard_Universityhttps://en.wikipedia.org/wiki/Bioengineering


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the journal Science Translational Medicine.[15]

10 Epidemiology and economics

Corneal transplant is one of the most common trans-

plant procedures.[16] Although approximately 100,000

procedures are performed worldwide each year, some

estimates report that 10,000,000 people are affected

by various disorders that would benefit from corneal

transplantation.

InAustralia, approximately 1,500 grafts are performed

each year. According to theNHS Blood and Transplant,

over 2,300 corneal transplant procedures are performedeach year in theUnited Kingdom. Between April 1,

2005 and March 31, 2006, 2,503 people received corneal

transplants in the UK.

In theUnited States, the cost is usually covered in part by

Medicare and health insurers. Reimbursement depends

on the patients personal healthcare provider. Usually

80% of the cost will be covered by the patients health

insurance. Those on Medicare will be reimbursed up

to $1,200 while the remainder is left up to the patient.

The average cost of the procedure ranges from $7,500 to

$11,000.

In 2005, there were about 32,840 corneal transplant re-

cipients. The estimated first year billed charges per pa-

tient, including medications, was $19,100. There were

a larger number of transplants for patients over 65 than

under, 18,000 compared to 14,840. There were 41,652

corneal transplants performed in the United States in

2008.[17]

InSwedenand many other European countries, corneal

transplants are paid by taxes. Every year about six hun-

dred of these operations are performed.

11 Footnotes

[1] Eye Banking FAQs. Eye Bank Association of America.

Retrieved 2011-12-29.

[2] Descemets Stripping Automated Endothelial Kerato-

plasty Outcomes Compared with Penetrating Kerato-

plasty from the Cornea Donor Study

[3] Cornea transplant Risks - Tests and Procedures - Mayo

Clinic

[4] Vladimir Filatov, peoples.ru

[5] Eye repair-TIME, Monday, Apr. 13, 1936

[6] Castroviejo R (1948).Keratoplasty for the Treatment of

Keratoconus. Trans Am Ophthalmol Soc46: 12753.

PMC 1312756.PMID 16693468.

[7] Castroviejo, R.: International Abstract of Surgery, 65:5,

December, 1937.

[8] The Boston Keratoprosthesis. Cataract & Refractive

Surgery Today. September 2009.

[9] Hicks CR, Crawford GJ, Dart JK, Grabner G, Holland

EJ, Stulting RD, Tan DT, Bulsara M (October 2006).

AlphaCor: Clinical outcomes. Cornea 25 (9): 103442. doi:10.1097/01.ico.0000229982.23334.6b. PMID

17133049.

[10] Ocular Systems Company Website

[11] Evans, Matt.Triad Business Journal, February 6, 2009.

[12] Shrewsbury and Telford Hospital NHS Trust Website

[13] Calderdale and Huddersfield NHS Trust website

[14] New way to regrow human corneas | Harvard Gazette

[15] Salynn Boyles. WebMD, August 25, 2010.

[16] Transplant gives woman new look at lifes. Windsor Star.

8 August 2009. Retrieved 1 September 2009.

[17] Eye Bank Association of America 2008 Eye Banking Sta-

tistical Report

12 References

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AID=/20060419/CUSTOMPUB01/60413016/

$-$1/ZONES04
http://www.indystar.com/apps/pbcs.dll/article?AID=/20060419/CUSTOMPUB01/60413016/-1/ZONES04http://www.indystar.com/apps/pbcs.dll/article?AID=/20060419/CUSTOMPUB01/60413016/-1/ZONES04http://www.indystar.com/apps/pbcs.dll/article?AID=/20060419/CUSTOMPUB01/60413016/-1/ZONES04http://dro.hs.columbia.edu/icrs.htmhttp://www.vision-institute.com/techniques/ptk.htmlhttp://www.vision-institute.com/techniques/ptk.htmlhttp://www.crstoday.com/PDF%20Articles/1104/crst1104_pr.pdfhttp://www.crstoday.com/PDF%20Articles/1104/crst1104_pr.pdfhttp://biomed.brown.edu/Courses/BI108/2006-108websites/group11corneal%20implants/index.htmlhttp://biomed.brown.edu/Courses/BI108/2006-108websites/group11corneal%20implants/index.htmlhttp://biomed.brown.edu/Courses/BI108/2006-108websites/group11corneal%20implants/index.htmlhttps://en.wikipedia.org/wiki/Windsor_Starhttp://www.windsorstar.com/health/Transplant+gives+woman+look+life/1871385/story.htmlhttp://www.webmd.com/eye-health/news/20100825/first-biosynthetic-corneas-implantedhttp://news.harvard.edu/gazette/story/2014/07/new-way-to-regrow-human-corneas/http://www.cht.nhs.uk/services/clinical-services-a-z/surgery-anaesthetics/ophthalmic-services/http://www.sath.nhs.uk/media/news_archive/Pioneering-eye-surgery.aspxhttp://triad.bizjournals.com/triad/stories/2009/02/09/story12.htmlhttp://www.ocularsystemsinc.com/physicians/services.htmhttps://www.ncbi.nlm.nih.gov/pubmed/17133049https://en.wikipedia.org/wiki/PubMed_Identifierhttp://dx.doi.org/10.1097%2F01.ico.0000229982.23334.6bhttps://en.wikipedia.org/wiki/Digital_object_identifierhttps://en.wikipedia.org/wiki/Corneahttp://meta.wkhealth.com/pt/pt-core/template-journal/lwwgateway/media/landingpage.htm?an=00003226-200610000-00007http://bmctoday.net/crstoday/2009/09/article.asp?f=CRST0909_16.phphttps://www.ncbi.nlm.nih.gov/pubmed/16693468https://en.wikipedia.org/wiki/PubMed_Identifierhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC1312756https://en.wikipedia.org/wiki/PubMed_Centralhttps://en.wikipedia.org/wiki/Trans_Am_Ophthalmol_Sochttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC1312756https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1312756https://en.wikipedia.org/wiki/TIMEhttp://www.time.com/time/magazine/article/0,9171,755981,00.htmlhttp://www.peoples.ru/medicine/ophthalmologist/vladimir_filatov/http://www.mayoclinic.com/health/cornea-transplant/MY00491/DSECTION=riskshttp://www.mayoclinic.com/health/cornea-transplant/MY00491/DSECTION=riskshttp://www.ncbi.nlm.nih.gov/pmc/articles/PMC2959124/http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2959124/http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2959124/http://www.restoresight.org/about-us/frequently-asked-questions/https://en.wikipedia.org/wiki/Swedenhttps://en.wikipedia.org/wiki/United_Stateshttps://en.wikipedia.org/wiki/United_Kingdomhttps://en.wikipedia.org/wiki/NHS_Blood_and_Transplanthttps://en.wikipedia.org/wiki/Australia


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8 13 EXTERNAL LINKS

http://www.news.com.au/story/0,10117,

18829980-29277,00.html http://www.cnyeyecare.com/newdetail.php?id=21

http://science.howstuffworks.com/news-item94.

htm

http://www.milliman.com/expertise/

healthcare/publications/rr/pdfs/

US-Organ-Tissue-Transplant-2005-RR.pdf

http://www.milliman.com/expertise/

healthcare/publications/rr/pdfs/

US-Organ-Tissue-Transplant-2006-RR.pdf

http://www.niios.com/content.php?na=9#

publications

http://www.cht.nhs.uk/services/

clinical-services-a-z/surgery-anaesthetics/

ophthalmic-services/

13 External links

Facts About the Cornea and Corneal DiseaseThe

National Eye Institute (NEI)
http://www.nei.nih.gov/health/cornealdisease/index.asphttp://www.cht.nhs.uk/services/clinical-services-a-z/surgery-anaesthetics/ophthalmic-services/http://www.cht.nhs.uk/services/clinical-services-a-z/surgery-anaesthetics/ophthalmic-services/http://www.cht.nhs.uk/services/clinical-services-a-z/surgery-anaesthetics/ophthalmic-services/http://www.niios.com/content.php?na=9#publicationshttp://www.niios.com/content.php?na=9#publicationshttp://www.milliman.com/expertise/healthcare/publications/rr/pdfs/US-Organ-Tissue-Transplant-2006-RR.pdfhttp://www.milliman.com/expertise/healthcare/publications/rr/pdfs/US-Organ-Tissue-Transplant-2006-RR.pdfhttp://www.milliman.com/expertise/healthcare/publications/rr/pdfs/US-Organ-Tissue-Transplant-2006-RR.pdfhttp://www.milliman.com/expertise/healthcare/publications/rr/pdfs/US-Organ-Tissue-Transplant-2005-RR.pdfhttp://www.milliman.com/expertise/healthcare/publications/rr/pdfs/US-Organ-Tissue-Transplant-2005-RR.pdfhttp://www.milliman.com/expertise/healthcare/publications/rr/pdfs/US-Organ-Tissue-Transplant-2005-RR.pdfhttp://science.howstuffworks.com/news-item94.htmhttp://science.howstuffworks.com/news-item94.htmhttp://www.cnyeyecare.com/newdetail.php?id=21http://www.news.com.au/story/0,10117,18829980-29277,00.htmlhttp://www.news.com.au/story/0,10117,18829980-29277,00.html


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14 Text and image sources, contributors, and licenses

14.1 Text

Corneal transplantationSource: http://en.wikipedia.org/wiki/Corneal_transplantation?oldid=622694495Contributors:Ronz, Iain, Ehn,Markhurd, Oobopshark, Smurfix, Chowbok, Rich Farmbrough, Barista, Bender235, MBisanz, Cherry blossom tree, Remember, Arca-dian, Hooperbloob, Wouterstomp, Stephan Leeds, H2g2bob, Killing Vector, Benbest, Feantur, Allen3, Rjwilmsi, AED, Gurch, Kol-basz, Antdos, Spencerk, YurikBot, Hawaiian717, Gaius Cornelius, Eleassar, Kgf0, SmackBot, David Kernow, Gary2863, TimBentley,KaiserbBot, JonHarder, Niels Olson, MrRadioGuy, Nakon, SilkTork, Mgiganteus1, Soulkeeper, RyanMikulovsky, Hu12, Ewulp, Cm-drObot, MonheitLaw, Karuna8, BrownBI108 11, Thijs!bot, Fournax, CopperKettle, Nakrian, Nimakha, Dantheman531, Milton Stanley,Kauczuk, Kaelian, EyeMD, Buckrogers77, MER-C, Instinct, Magioladitis, King harvest, Appraiser, Hawkaris, TRMite, Wikianon, Nfos-tiras, D Dinneen, Nono64, J.delanoy, OttoMkel, Skier Dude, Gurchzilla, Dridus, Lucifero4, Robertofreda, Philip Trueman, UNMBOY,Jmh649, Sfears, SiNNaTaS, Wlamping, Loren.wilton, ClueBot, Tonysterrett, PixelBot, Jonhanneman, Intacs, XLinkBot, Delicious car-buncle, Dutchpearls, Addbot, Landon1980, Alfie66, Yobot, WikiDan61, Legobot II, Iroony, NWs Public Sock, Xqbot, JimVC3, Kat384,BrentStone, Corneadoc, FrescoBot, LucienBOT, Tobby72, DrilBot, Descemet, HRoestBot, Luki1987, Irbisgreif, Venujustforu, Pwsoneil,Dbglasser, Lasik Egypt, Angelito7, Klufas, Charbon, Kiatdd, Anselmo82, Neechalkaran, H3llBot, Cimmerian praetor, LibertyOrDeath,Rharrias99, ClueBot NG, AwamerT, MrBill3, Pakremer, Rytyho usa, Kcorcoran951, Manabeast333, TylerDurden8823, Megor1, Em-

mariatom, Dozzzzzzzzzing off, Harshit Koshta, K18s, Fmusa, Monkbot, Musogd and Anonymous: 102

14.2 Images

File:A_human_eye_1_day_after_a_cornea_transplant.jpg Source: http://upload.wikimedia.org/wikipedia/commons/6/69/A_human_eye_1_day_after_a_cornea_transplant.jpgLicense:CC-BY-SA-3.0Contributors:Photo taken by me Original artist:Megor1

File:Cornea_Transplant.jpg Source: http://upload.wikimedia.org/wikipedia/commons/2/2d/Cornea_Transplant.jpgLicense: CC-BY-3.0Contributors:Own workOriginal artist:Megor1

File:Eduard_Konrad_Zirm.JPG Source: http://upload.wikimedia.org/wikipedia/commons/3/38/Eduard_Konrad_Zirm.JPG License:

Public domain Contributors: retrieved from SL. Moffatt, VA. Cartwright, TH. Stumpf. Centennial review of corneal transplantation.Clin Experiment Ophthalmol. 33 (6), s. 642-57, 2005. doi:10.1111/j.1442-9071.2005.01134.x. PMID 16402960. Original artist:

unknown/anonymous

File:Question_book-new.svgSource: http://upload.wikimedia.org/wikipedia/en/9/99/Question_book-new.svgLicense:? Contributors:

Created from scratch in Adobe Illustrator. Based onImage:Question book.pngcreated byUser:EquazcionOriginal artist:

Tkgd2007

File:Ramoncastroviejo.jpg Source: http://upload.wikimedia.org/wikipedia/commons/0/02/Ramoncastroviejo.jpgLicense: Public do-mainContributors:http://www.bermemar.com/Original artist:Unknown

File:Text_document_with_red_question_mark.svg Source: http://upload.wikimedia.org/wikipedia/commons/a/a4/Text_document_with_red_question_mark.svgLicense: Public domain Contributors:Created bybdeshamwith Inkscape; based upon Text-x-generic.svgfrom the Tango project. Original artist:Benjamin D. Esham (bdesham)

14.3 Content license

Creative Commons Attribution-Share Alike 3.0
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