Corneal Transplantation (Corneal Grafting)

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What is a Corneal Transplant?

A corneal transplant is an operation to replace a damaged or cloudy cornea with healthy donor corneal tissue. The cornea is the clear front window of the eye that helps focus light. When it becomes scarred, swollen, or misshapen, vision may become blurred or painful.

 

Why Might I Need a Corneal Transplant?

A transplant may be recommended if you have:

• Keratoconus (progressive thinning and bulging of the cornea)

• Fuchs’ endothelial dystrophy

• Corneal scarring from infections or injury

• Corneal swelling (edema)

• Irregular astigmatism

• Failure of a previous graft

 

Types of Corneal Transplant Surgery

1. Penetrating Keratoplasty (PK or Full-Thickness Transplant)

• Entire thickness of the cornea is replaced.

• Used when damage affects all corneal layers (e.g., deep scars).

• Longer healing time (months to a year).

2. Partial-Thickness Transplants

These replace only the damaged layers while preserving the healthy parts.

a) DSAEK (Descemet’s Stripping Automated Endothelial Keratoplasty)

• Replaces the inner endothelial layer.

• Common for Fuchs’ dystrophy or corneal swelling.

• Smaller incision, faster recovery than PK.

b) DMEK (Descemet Membrane Endothelial Keratoplasty)

• Removes and replaces only the thinnest inner layer.

• Fastest recovery; best quality of vision.

• Technically delicate surgery.

c) DALK (Deep Anterior Lamellar Keratoplasty)

• Replaces the corneal front layers while keeping the patient’s endothelium.

• Used for conditions like keratoconus.

• Lower risk of rejection than PK.

 

Benefits of Corneal Transplantation

• Improved vision

• Reduced pain caused by corneal disease

• Better appearance of a damaged or scarred eye

• Lower risk of serious complications with modern partial-thickness techniques

 

Before the Surgery

• You may need eye scans, measurements, and general health checks.

• Your doctor will review medications (some may need to be paused).

• You must avoid eye makeup and contact lenses shortly before surgery.

 

The Procedure

• Usually done under local anesthesia with sedation, sometimes general anesthesia.

• Surgery typically takes 30–90 minutes depending on the technique.

• You go home the same day in most cases.

 

Recovery and Aftercare

• Use prescribed eye drops (antibiotic + anti-inflammatory) for several months.

• Attend regular follow-up appointments.

• Avoid rubbing the eye.

• Protect the eye using a shield at night.

• Avoid swimming or heavy lifting for several weeks.

• Glasses or contact lenses may still be needed for best vision.

Healing time varies:

• DMEK/DSAEK: weeks to a few months

• DALK/PK: several months to a year

 

Possible Risks and Complications

All surgery carries risks. Your surgical team will discuss these with you.

Common or Expected Effects

• Blurred vision during early healing

• Light sensitivity

• Mild discomfort or watering

Specific Risks of Corneal Transplant

1. Graft Rejection

• Immune system attacks the donor tissue

• Occurs in ~10–20% of full-thickness grafts (much lower in DMEK/DALK)
  Warning signs: redness, sensitivity to light, worsening vision, pain
  Prompt treatment can often reverse it.

2. Infection

• Can occur inside or around the eye

• Requires urgent treatment

3. Raised Eye Pressure (Glaucoma)

• Sometimes caused by steroid drops

• Usually managed with medication

4. Graft Failure

• The transplant becomes cloudy over time

• May require repeat surgery

5. Astigmatism (Irregular Corneal Shape)

• May need glasses, contact lenses, or minor surgical adjustments

6. Problems With Healing or Sutures (for PK/DALK)

• Stitches may loosen, break, or cause irritation

 

When to Seek Urgent Help

Contact your eye clinic or emergency department if you experience:

• Sudden decrease in vision

• Increasing redness or pain

• Sensitivity to light

• A feeling that something is in the eye

• Discharge or swelling

These may be signs of infection or rejection.

 

Frequently Asked Questions

Will I still need glasses?

Possibly. Many patients need glasses or contact lenses for the best vision, especially after full-thickness grafts.

Is the donor tissue safe?

Yes. Donor corneas are screened carefully for infections and quality.

How long does a transplant last?

Grafts often last many years; partial-thickness grafts may have longer survival rates.