Does a corneal transplant require immunosuppressants?

I think it does, but can find no confirmation of this.

I may need this procedure one day, I have kerarokonus.

That link above will expose folks to some horrifying pictures.

Short answer: For low-risk corneal transplants, immunosuppression may not be necessary.

For high risk ones, it is.

Your opthalmologist can tell you which category you might fall into, and supply more details.

I am only mentioning this in case you want to do a search, but the correct spelling is keratoconus.

Just a word of encouragement - my aunt suffered from this for years. She underwent two transplants in the early and late 1980s, and her eyesight has generally been fine since.

Her eyeglass prescription is a bit complex, and she can’t take advantage of cheap glasses sales at Sears, but she’s heading into her retirement years with comparatively few issues.

Thanks, hopefully I won’t end up needing the transplant, so I won’t need to find out.

Thanks, I wrote the OP on my phone, so I’m surprised I got it wrong.

Thanks, I’m glad to hear that.

I had keratoconus also and got corneal transplants for both eyes in 2004 (one in May, one in October). No immunosuppressants were necessary. According to the doctor, this is because the cornea is not attached to the circulatory system and so doesn’t have the exposure to the immune system that something like a kidney would have.

By the way, you might want to start talking to surgeons early. I waited nearly 10 years to get it done and really, really wish I had done it sooner. My first couple of doctors had felt like waiting as long as possible was desirable, but I was miserable with every variation of contact we tried. Finally I moved and found a new doctor who couldn’t believe that I’d been advised to wait so long. The results were nothing short of miraculous… In my left eye, I see better uncorrected (20/25) after the surgery than I could with the best correction from contacts (which had peaked around 20/35). My right eye was also great post-surgery (20/40 uncorrected) until they took the stitches out and now it’s back to virtually worthless (20/140 or so, with an astigmatism that’s too severe to do much about unless I want to try another surgery).

The inside of the eyeball is - crap, I don’t remember the term*; “immunologically privileged”, perhaps? - anyway, the immune system doesn’t “see” it. I’m coming at this from a biology point of view, not a medical one, but that’s probably why they’re not required in some cases, at least.

*I’m blaming my poor memory on my 34-hour-old baby. I can milk (heh) that excuse for all it’s worth.

The most basic reason that low-risk transplants don’t need immunosuppressants is that most normal corneas get their oxygen directly from the air, not from blood circulation. No hemoglobin is needed, so no vasculature is needed. Nutrients are provided in the local fluids that diffuse in from the anterior chamber. Which is good; when blood vessels are in the cornea, it’s not such a good cornea for seeing through.

However, many disease states cause neovascularization of the cornea. Blood vessels become much more pronounced on the eye’s surface, including the cornea. Blood vessels not only interfere with vision when they’re in the cornea, but they bring the immune cells into contact with the cornea.

So if the corneal bed is rich in blood vessels, and a new cornea is transplanted in, immunosuppressants may be neede to prevent rejection.

That’s a real simple version of one common reason for rejection.