Trasplante de córnea

Qué es el trasplante de córnea?

El trasplante de córnea, también conocido como queratoplastia, injerto corneal o trasplante ocular, consiste en la extirpación de tejido corneal deformado o que ha perdido su transparencia, y su sustitución por tejido corneal sano tomado de un donante fallecido. El trasplante de córnea es la cirugía de trasplante más realizada y con más éxito, con más de 40.000 intervenciones al año.

 

Por qué se realiza un trasplante de córnea?

El trasplante de córnea se realiza para tratar las siguientes afecciones:

  • Un aumento de la opacidad de la córnea debido a que las células de la córnea están dañadas.
  • Queratocono, que es la afección en la que la córnea adopta una forma cónica, impidiendo la visión.
  • Enfermedades hereditarias de la córnea.
  • Tejido cicatricial o neovascularización que se producen como consecuencia de infecciones corneales, por ejemplo el virus del herpes simple, VHS.
  • Formación de manchas en la córnea tras una lesión.

 

En estos casos o cuando una córnea trasplantada es rechazada por el organismo, se recomienda una transferencia de córnea.

 

Cuáles son las condiciones para el trasplante de córnea?

Para beneficiarse plenamente de un trasplante de córnea, la estructura del ojo del paciente debe estar sana, aparte de la córnea. Si hay algún daño en la retina del paciente, el trasplante de córnea no aportará ningún beneficio. En concreto, un oftalmólogo determinará si un paciente se beneficiará de un trasplante de córnea tras realizarle una ecografía oftalmológica.

 

Turquía tiene dos "bancos de ojos" principales, uno en Estambul y otro en Ankara. Los bancos de ojos se encargan de almacenar las córneas donadas, determinar si el tejido es apto para el trasplante y entregarlo a los centros donde se realizará el trasplante de córnea. Las córneas se toman de donantes de órganos recientemente fallecidos que tienen tejidos de córnea sanos. Se comprueba que las córneas estén sanas y no transmitan ninguna enfermedad. La córnea es un tejido no vascular, por lo que no se requiere compatibilidad con el grupo sanguíneo.

 

Qué hay que tener en cuenta antes del trasplante de córnea?

Antes de la intervención, el paciente se somete a un examen oftalmológico completo para garantizar que el procedimiento será seguro y eficaz. Se pide al paciente que se mida el ojo antes de llegar a Turquía para encontrar una córnea donante de tamaño similar. Además, es posible que el paciente deba dejar de tomar ciertos medicamentos, por lo que el oftalmólogo que le atiende revisa su historial médico. El paciente debe llegar a Turquía un día antes de la intervención.

 

Cómo se realiza el trasplante de córnea?

Antes de comenzar la intervención se administra anestesia general o, normalmente, local. Se aplica anestesia local en los ojos y las zonas circundantes. A continuación se limpian a fondo los párpados para minimizar el riesgo de infección. Se coloca un pequeño instrumento entre los párpados para mantenerlos abiertos durante la intervención. El cirujano determina el diámetro de la córnea que se utilizará para el trasplante corneal y retira cuidadosamente las partes dañadas de la córnea a través de una incisión realizada con un instrumento especial.Si está previsto realizar simultáneamente una cirugía de cataratas, en este momento se retira la catarata y se coloca una lente intraocular en lugar del cristalino. A continuación, se coloca la córnea donante transparente en el lecho receptor y se sutura con métodos microquirúrgicos. Al final de la operación, se aplica al ojo una pomada antibiótica y se cierra el ojo con una cubierta protectora.

 

La intervención dura entre 30 minutos y una hora y se realiza ojo por ojo.

 

Qué hay que tener en cuenta tras el trasplante de córnea?

Después de la cirugía, se recomienda a los pacientes lo siguiente:

  • Los pacientes deben utilizar sus medicamentos recetados según las instrucciones de su oftalmólogo.
  • Los pacientes no deben ejercer presión física sobre los ojos ni frotárselos.
  • Los pacientes deben lavarse el pelo con la cabeza inclinada, de forma similar a como se hace en una peluquería, para que no les entre agua ni jabón en los ojos.
  • Los pacientes deben llevar gafas de sol cuando estén al aire libre.
  • Los pacientes deben evitar ejercicios extenuantes como nadar, levantar peso o montar en bicicleta.

 

El oftalmólogo que le atienda decidirá cuándo se retirarán los puntos tras la intervención. Normalmente, los puntos se retiran unos meses después de la intervención.

 

Cuáles son los riesgos del trasplante de córnea?

El trasplante de córnea tiene una tasa media de rechazo del 5%, esta baja tasa se debe a que la córnea no suele tener vasos sanguíneos y la falta de circulación sanguínea hace menos probable una respuesta del sistema inmunitario. Los riesgos del trasplante de córnea son, entre otros, los siguientes:

  • Infección
  • Hemorragia
  • Exceso de presión ocular, glaucoma
  • Separación de las capas internas del ojo, desprendimiento de retina
  • Rechazo de la córnea recién trasplantada

 

Un trasplante de córnea puede repetirse si es necesario sin inconvenientes significativos. La irregularidad corneal postoperatoria puede ralentizar la recuperación de la visión. Sin embargo, la visión mejorará gradualmente en el plazo de un año tras la intervención.

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