Trapianto di Cornea

Cos’è il Trapianto di cornea?

Trapianto di cornea, noto anche come cheratoplastica, innesto corneale o trapianto dell’occhio, prevede la rimozione di tessuto corneale deformato o che ha perso la sua trasparenza, sostituendolo con tessuto corneale sano prelevato da un donatore deceduto. Il trapianto di cornea è l’intervento chirurgico di trapianto più comunemente eseguito e di successo, con oltre 40.000 interventi effettuati ogni anno.

Perché viene eseguito il trapianto di cornea?

Il trapianto di cornea viene eseguito per trattare le seguenti condizioni:

  • Un aumento dell’opacità corneale dovuto al danneggiamento delle cellule corneali.
  • Cheratocono, una condizione in cui la cornea assume una forma conica, impedendo la visione.
  • Malattie ereditarie della cornea.
  • Tessuto cicatriziale o neovascolarizzazione che si verificano a seguito di infezioni corneali, ad esempio il virus dell'herpes simplex, HSV.
  • Formazione di macchie sulla cornea dopo un trauma.

Un trapianto di cornea è consigliato in questi casi o quando una cornea trapiantata viene respinta dal corpo.

Quali sono le condizioni per il trapianto di cornea?

Per trarre pieno vantaggio da un trapianto di cornea, la struttura dell’occhio del paziente deve essere sana a parte la cornea. Se c’è qualche danno alla retina del paziente, non ci saranno benefici dal trapianto di cornea. In particolare, se un paziente trarrà beneficio da un trapianto di cornea verrà determinato da un oftalmologo dopo aver eseguito un’ecografia oftalmologica.

In Turchia ci sono 2 principali “banche degli occhi”, una a Istanbul e l’altra ad Ankara. Le banche degli occhi sono responsabili della conservazione delle cornee donate, della determinazione della idoneità del tessuto per il trapianto e della consegna ai centri dove verrà eseguito il trapianto di cornea. Le cornee vengono prelevate da donatori di organi recentemente deceduti che hanno tessuti corneali sani. Ci si assicura che le cornee siano sane e non trasmettano malattie. La cornea è un tessuto non vascolare, quindi non è richiesta la compatibilità di gruppo sanguigno.

Quali sono le cose da considerare prima del trapianto di cornea?

Prima dell’intervento chirurgico, al paziente viene eseguito un accurato esame oculare per garantire che la procedura sia sicura ed efficace. Si chiede al paziente di misurare l’occhio prima di arrivare in Turchia per trovare una cornea donatrice compatibile delle dimensioni simili. Inoltre, potrebbe essere necessario interrompere l’assunzione di determinati farmaci e la storia clinica del paziente viene valutata dall’oftalmologo curante. Il paziente dovrebbe arrivare in Turchia un giorno prima dell'intervento chirurgico.

Come viene eseguito il trapianto di cornea?

Prima dell’inizio dell’intervento chirurgico viene somministrata l’anestesia generale o, di solito, l’anestesia locale. L’anestesia locale viene applicata agli occhi e alle aree circostanti. Successivamente, le palpebre vengono pulite accuratamente per ridurre al minimo il rischio di infezione. Un piccolo strumento viene posizionato tra le palpebre per mantenerle aperte durante l’intervento chirurgico. Il chirurgo determina il diametro corneale da utilizzare per il trapianto di cornea e rimuove attentamente le parti danneggiate della cornea attraverso un'incisione effettuata con uno strumento speciale. Se è previsto anche un intervento chirurgico per la cataratta, in questo momento viene rimossa la cataratta e viene posizionata una lente intraoculare al posto della lente naturale dell'occhio. Successivamente, la cornea trasparente del donatore viene posizionata sul letto del ricevente e suturata utilizzando metodi microchirurgici. Alla fine dell’operazione, viene applicata una pomata antibiotica all'occhio e l'occhio viene chiuso con una copertura protettiva.

L'intervento chirurgico dura da 30 minuti a un'ora e viene eseguito un occhio alla volta.

Quali sono le cose da considerare dopo il trapianto di cornea?

Dopo l’intervento chirurgico, al paziente viene raccomandato di:

  • Utilizzare i farmaci prescritti come indicato dal proprio oculista.
  • Non esercitare alcuna pressione fisica sugli occhi e non strofinarli.
  • Lavare i capelli con la testa inclinata, in modo simile a quanto viene fatto dal parrucchiere, per evitare che acqua o sapone entrino negli occhi.
  • Indossare occhiali da sole quando si è all’aperto.
  • Evitare esercizi intensi come nuoto, sollevamento pesi o ciclismo.

L’oculista che segue il paziente deciderà quando rimuovere i punti di sutura dopo l’intervento chirurgico. Di solito, i punti vengono rimossi alcuni mesi dopo l’intervento.

 

Quali sono i rischi del trapianto di cornea?

Il trapianto di cornea ha un tasso medio di rigetto del 5%. Questo basso tasso è dovuto al fatto che la cornea di solito non ha vasi sanguigni e alla mancanza di circolazione sanguigna, che rende meno probabile una risposta del sistema immunitario. I rischi del trapianto di cornea includono, ma non si limitano a:

  • Infezione
  • Sanguinamento
  • Eccesso di pressione oculare, glaucoma
  • Separazione degli strati interni dell’occhio, distacco della retina
  • Rigetto della cornea appena trapiantata

Un trapianto di cornea può essere ripetuto se necessario senza drawback significativi. L’irregolarità corneale postoperatoria può rallentare il recupero della vista. Tuttavia, la vista migliorerà gradualmente entro un anno dall'intervento.

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