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Corneal Transplantation

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What causes a cataract?

What is a cornea?

Your cornea must be clear, smooth, and healthy for good vision. If it is scarred, swollen, or damaged, light is not focused properly into the eye. As a result, your vision is blurry or you see glare.

If your cornea cannot be healed or repaired, your ophthalmologist may recommend a corneal transplant.

There are different types of corneal transplants. In some cases, only the front and middle layers of the cornea are replaced. In others, only the inner layer is removed. Sometimes, the entire cornea needs to be replaced.

What causes corneal problems?

Eye disease and injuries can damage the cornea. Here are some common eye problems that can lead to a damaged cornea:

  • Keratoconus, where the cornea is cone-shaped rather than dome-shaped
  • Fuchs’ Dystrophy, where cells in the inner layer of the cornea are not working effectively
  • Eye infections or injuries that scar the cornea
  • Previous corneal surgery or other eye surgery that damaged the cornea

Types of Corneal Procedures

Full-Thickness Corneal Transplant (PK)

If all layers of the cornea are damaged, the entire cornea may be replaced. This procedure is called penetrating keratoplasty (PK). The damaged cornea is removed and a donor cornea is stitched into place. Recovery can take a year or longer, and the risk of rejection is slightly higher than with other procedures.

With a PK, there is a slightly higher risk than with other types of corneal transplants that the cornea will be rejected. This is when the body’s immune system attacks the new cornea tissue. Click to Watch Video

Partial-Thickness Corneal Transplant (DALK)

If only the front layers of the cornea are damaged, those layers can be replaced while the inner layer remains intact. This procedure, called deep anterior lamellar keratoplasty (DALK), is commonly used for keratoconus. Healing is faster than with full-thickness transplants, and the risk of rejection is lower.

Endothelial Procedures (DSEK/DSAEK, DMEK, or DSO)

When the innermost layer of the cornea (the endothelium) is damaged, treatment may focus only on this layer.

  • DSEK/DSAEK or DMEK: These procedures replace the damaged inner layer with healthy donor tissue through a small incision. They usually require few or no stitches and offer faster recovery with a lower risk of rejection than full-thickness transplants. DMEK uses thinner donor tissue and often allows for quicker visual recovery.
  • Descemet Stripping Only (DSO): In select patients, the damaged inner membrane is gently removed without placing donor tissue. Your own healthy endothelial cells then migrate to heal the area naturally. Because no donor tissue is used, there is no risk of graft rejection.

Your eye surgeon will recommend the most appropriate procedure based on your corneal condition and healing potential.

What to expect when you have a corneal transplant

Days or Weeks Before Your Transplant

  • Your ophthalmologist will explain why a corneal transplant is needed, how it may improve your vision, and what to expect before and after surgery.
  • A surgery date will be scheduled, though it may change if a donor cornea is not available.
  • Tell your ophthalmologist about all medications you take. You may be asked to stop certain medications, such as blood thinners.
  • You may need a medical clearance or brief exam to make sure you are healthy enough for surgery.
  • Arrange for someone to drive you home, as you will not be able to drive after surgery.

The Day of Your Transplant

  • A corneal transplant is performed as an outpatient procedure, meaning you go home the same day.
  • Eye drops will be placed in your eye, and you may receive medication to help you relax.
  • Your surgeon will use local anesthesia (numbing the eye) or general anesthesia so you do not feel pain.
  • A small device will hold your eye open. Because of the anesthesia, you will see little or nothing.
  • After surgery, a protective shield is placed over your eye.
  • You will be monitored in recovery and can go home once it is safe.
  • Your ophthalmologist will explain how to care for your eye at home.

After Your Transplant

  • You will return to your ophthalmologist’s office the day after surgery for an eye exam.
  • Follow these recovery instructions:
    • Use eye drops exactly as prescribed
    • Do not rub or press on your eye
    • Take approved over-the-counter pain medication if needed
    • Wear glasses or an eye shield to protect your eye
    • Ask when you can return to normal activities
    • Some patients may need to lie on their back for a period of time to help healing
    • Call your ophthalmologist with any concerns or questions

Possible Problems After Corneal Transplant

Rejection occurs when the body’s immune system attacks the transplanted tissue. It is more common with full-thickness transplants and less common with partial procedures. Early treatment can sometimes reverse rejection.

Warning signs of rejection include:

  • Eye pain
  • Light sensitivity
  • Redness
  • Cloudy or blurry vision

Contact your ophthalmologist right away if you notice these symptoms.

  • Other possible complications include:
    • Infection
    • Bleeding
    • Retinal detachment
    • Glaucoma (increased eye pressure)
  • Even with a successful transplant, vision may be affected by astigmatism or other eye diseases.
  • Some patients may need more than one corneal transplant. Repeat transplants carry a higher risk of rejection.

An Opportunity for Clear Vision

If you have a damaged or diseased cornea, you and your ophthalmologist will review your options. For many patients, corneal transplant surgery can restore clearer vision and improve quality of life.