Iran (IMNA) -In the following interview, Mohsen Pourazizi, a cornea fellowship-trained ophthalmologist and faculty member at Isfahan University of Medical Sciences addresses key clinical questions: which patients require corneal transplantation, how corneal donation differs from solid organ donation, success rates, potential complications, recovery timelines, barriers to donation, and modern lamellar surgical techniques. His insights clarify why corneal transplantation remains a mainstay of ophthalmic practice and how Iran's capabilities now parallel those of leading centers in Europe and the United States.
Regarding which patients are candidates for receiving a corneal graft, the cornea specialist explained that corneal transplantation is widely regarded as one of the most successful forms of solid tissue transplantation in modern medicine. Patients who may require a corneal graft are those who have experienced a loss of corneal clarity—and consequently, a decline in visual acuity—due to various etiologies, including inherited or acquired diseases, ocular infections, or trauma. He noted that one of the most prevalent conditions in the Middle East is keratoconus; in its advanced stages, keratoconus frequently necessitates corneal transplantation. Other indications include corneal scarring following trauma or infection. Additionally, surgical damage to the inner layers of the cornea during intraocular procedures can lead to endothelial decompensation. Once endothelial cell function falls below a critical threshold, these patients may require lamellar keratoplasty.
On the topic of from whom and under what conditions corneal tissue is donated, Dr. Pourazizi stated that corneal tissue is typically recovered from deceased individuals who, during their lifetime, provided consent for tissue donation, or whose families have granted posthumous authorization. Nearly any individual, regardless of age or sex, can become a corneal donor, provided they do not have a transmissible infectious disease. Recovery must take place within the first 24 hours following death.
When asked about the success rate of corneal transplantation, the faculty member at Isfahan University of Medical Sciences emphasized that corneal transplantation remains one of the most successful solid tissue grafts in medicine. In a large majority of cases, it can restore complete or functionally significant vision. Moreover, in many instances, corneal grafting helps preserve the structural integrity of the globe and prevents the need for evisceration or enucleation, thereby maintaining a natural ocular appearance. However, he cautioned that successful outcomes depend critically on the absence of severe underlying systemic disease and on a technically successful procedure.
Explaining how corneal donation differs from other forms of organ donation, the cornea specialist noted that unlike most other transplanted tissues, the cornea is an avascular structure. This lack of blood vessels significantly reduces the risk of immune-mediated graft rejection compared to vascularized organ transplants. In the majority of recipients, visual function improves substantially following transplantation. That said, outcomes are influenced by several variables, including the patient's underlying medical condition, adherence to postoperative care, and the surgical technique employed.
Regarding potential complications of corneal transplant surgery, the surgeon stated that as with any surgical procedure, corneal transplantation carries potential risks. These include postoperative infection, graft rejection, elevated intraocular pressure (secondary glaucoma), and persistent or recurrent blurred vision. Importantly, he noted that some of these complications are reversible or manageable with appropriate intervention. Regular postoperative follow-up, timely use of prescribed medications (including topical corticosteroids), and consistent patient compliance are essential to optimizing outcomes.
On the typical recovery period following a corneal transplant, Dr. Pourazizi explained that most patients begin to perceive an initial improvement in vision within the first few weeks after surgery. However, achieving the final visual outcome is a gradual process that may require up to 12 to 18 months of careful follow-up. During this period, sutures are selectively removed in a staged manner. Once suture removal is complete, a marked and often dramatic improvement in visual acuity is commonly observed.
Addressing why families sometimes consent to heart or kidney donation but refuse corneal donation, the cornea surgeon acknowledged that this is not uncommon. Despite agreeing to donate solid organs such as the heart, liver, or kidneys, some families hesitate to consent to corneal donation. The primary concern is often a fear of disfigurement or altered appearance of the deceased. In reality, he clarified that corneal tissue recovery is performed postmortem in an operating room setting, with the utmost precision and respect for the individual. The procedure results in no visible change to the appearance of the eyes or face. He emphasized that a single consent for corneal donation provides two corneas, which can restore sight to two individuals. Moreover, with advanced lamellar techniques, even more than two recipients may benefit from a single donor pair.
Finally, discussing the types of corneal transplantation currently available, the cornea specialist and faculty member at Isfahan University of Medical Sciences explained that corneal transplantation can be performed as penetrating keratoplasty (PKP), in which the recipient's full-thickness cornea is replaced with a donor graft. However, with modern surgical techniques, lamellar keratoplasty is increasingly preferred. Depending on whether the pathology involves the anterior stroma or the endothelium, either anterior lamellar keratoplasty (ALK) or endothelial keratoplasty (DSEK/DMEK) can be performed.
He noted that lamellar techniques offer several advantages over full-thickness grafting: a significantly lower risk of rejection, preservation of the recipient's own corneal integrity, shorter operative times, and superior visual outcomes.
He concluded by noting that in Iran, and specifically in the city of Isfahan, ophthalmic services in the field of corneal transplantation are fully comparable to those in Europe and the United States, and that every surgical technique currently available worldwide is performed there under excellent conditions.
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