On the day of the surgery, the patient is given a brief physical examination by the surgical team and is taken to the operating room in the hospital or an outpatient surgery center. A local or general anesthesia may be used, depending on the health, age of the patient and whether or not you prefer to be asleep during the procedure. With local anesthesia, an injection into the skin around your eye is used to relax muscles that control blinking and movement and eye drops are used to numb the eye itself.
An eyelid speculum is used to keep the lids open, along with suitable lubrication to prevent the eye from drying. A metal ring is then stitched to the sclera, which will provide a base for a trephine. The surgeon inspects and measures the affected corneal area in order to determine the size of the transplantation. A trephine is then placed over the cornea and is used by the surgeon to cut the host cornea. The trephine is then removed and the surgeon cuts a circular graft from the donor cornea. A tissue nearly identical in shape is then sutured into place. Once this is done, the surgeon returns to the patient's eye and removes the host cornea.
The donor cornea is then brought into the surgical field and maneuvered into place with forceps. Once in place, the surgeon will fasten the cornea to the eye with a running stitch (as used in the upper image above) or a multiple interrupted stiches (as in the lower image). The surgeon finishes up by reforming the anterior chamber with a sterile solution injected by a cannula, then testing that it's watertight by placing a dye on the wound exterior.
With the metal ring removed and antibiotic eye drops placed, 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 for the first post operative appointment.
A plastic shield will be put over your eye to protect it from being inadvertently rubbed or bumped. The procedure takes approximately two hours.