What is a corneal transplant?
A corneal transplant (keratoplasty) replaces part or all of a damaged cornea with healthy donor tissue. Because the cornea has no blood supply, it is among the most successful transplant procedures in medicine — yet it still requires careful evaluation, skilled surgery and committed long-term follow-up.
Modern keratoplasty is no longer “one operation”. Surgeons can replace only the affected layer, preserving the patient’s own healthy tissue wherever possible.
Types of keratoplasty
Penetrating keratoplasty (PK): full-thickness replacement of all five corneal layers, used when the entire cornea is diseased.
Deep anterior lamellar keratoplasty (DALK): replaces the front layers while keeping the patient’s own endothelium — lower rejection risk, but a more technically demanding operation.
Descemet stripping endothelial keratoplasty (DSEK/DSAEK): replaces only the innermost layers for endothelial failure such as Fuchs’ dystrophy.
Descemet membrane endothelial keratoplasty (DMEK): the thinnest, most anatomically precise inner-layer transplant, offering faster visual recovery in suitable eyes.
Which technique suits an eye depends entirely on which layers are diseased. This is determined by examination and anterior-segment OCT imaging.
Conditions that may require a transplant
Common indications include corneal scarring from infection or injury, advanced keratoconus that cannot be managed with lenses or other surgery, corneal dystrophies such as Fuchs’ dystrophy, and corneal failure after complicated eye surgery. Not every cloudy cornea needs a transplant — some conditions respond to medical or smaller surgical approaches, which is why specialist evaluation matters.
Evaluation and candidacy
Evaluation reviews the cause and extent of corneal damage, the health of the rest of the eye (a transplant cannot fix problems in the retina or optic nerve), eye pressure, and general health factors that affect healing. Realistic goal-setting is part of candidacy: a transplant aims to restore a clear window, and final vision depends on the whole eye working together.
Donor tissue is obtained through eye banks under regulated allocation; tissue availability and timelines vary and are not guaranteed at consultation.
The procedure and aftercare, in outline
Keratoplasty is typically performed under anaesthesia chosen for comfort and safety; the specifics are discussed beforehand. The damaged layer is removed and donor tissue is secured with fine sutures or, in endothelial procedures, supported by an air or gas bubble inside the eye.
Follow-up is intensive at first — visits within the first days and weeks, then at intervals for many months. Sutures (in PK/DALK) are adjusted or removed over time to refine the shape of the cornea. Protective eyewear, prescribed eye drops and avoiding eye rubbing are essential parts of recovery. Rejection episodes can occur months or years later, which is why long-term follow-up continues even when vision is good.
Risks and realistic expectations
Possible complications include rejection episodes, infection, raised eye pressure, astigmatism, and graft failure — each managed with specific treatment, and each reason why follow-up must not lapse. Success rates in corneal transplantation are among the highest in transplant medicine, but individual outcomes depend on the original diagnosis, the eye’s overall health and adherence to aftercare.