Corneal Transplant (Keratoplasty)
Corneal transplant, also known as keratoplasty, is a surgical procedure to replace part of the cornea with corneal tissue from a donor. The cornea is the clear, dome-shaped surface of the eye and plays a major role in focusing vision.
A corneal transplant can restore vision, reduce pain, and improve the appearance of a damaged or diseased cornea.
Most corneal transplants are successful. However, there is a small risk of complications, such as rejection of the donor cornea.
Why It Is Done
Corneal transplantation is often used to restore vision in people with damaged corneas. It may also relieve pain and other symptoms associated with corneal diseases.
Conditions that may be treated with corneal transplant include:
- Keratoconus (cornea bulging outward)
- Fuchs’ dystrophy
- Thinning of the cornea
- Corneal scarring caused by infection or injury
- Clouding of the cornea
- Corneal swelling
- Corneal ulcers, including those caused by infection
- Complications from previous eye surgery
Risks
Corneal transplant is relatively safe, but it carries a small risk of serious complications, such as:
- Eye infection
- Increased risk of cataracts (clouding of the lens)
- Increased pressure inside the eye (glaucoma)
- Problems with the stitches used to secure the donor cornea
- Rejection of the donor cornea
- Corneal swelling
Signs and Symptoms of Corneal Rejection
In some cases, the body’s immune system may mistakenly attack the donor cornea. This is called rejection and may require medical treatment or another transplant.
Contact your eye doctor if you notice:
- Vision loss
- Eye pain
- Redness
- Sensitivity to light
Rejection occurs in about 10% of corneal transplant cases.
Preparation
Before surgery, you will undergo:
- A comprehensive eye exam to identify conditions that may cause complications
- Eye measurements to determine the appropriate donor cornea size
- Review of all medications and supplements (some may need to be stopped)
- Treatment of any existing eye conditions such as infection or inflammation
Your doctor will also explain the procedure, expected outcomes, and potential risks.
Finding a Donor Cornea
Most donor corneas come from deceased donors. Unlike organs such as the liver or kidneys, patients usually do not have to wait long for a corneal transplant because many people choose to donate their corneas after death.
However, corneas from donors with certain medical conditions, infections, or unknown causes of death may not be used.
What to Expect
During the Procedure
On the day of surgery:
- You will receive a sedative to help you relax
- Local anesthesia will numb your eye (you will be awake but pain-free)
In the most common type of corneal transplant (penetrating keratoplasty):
- The surgeon removes a full-thickness circular section of the damaged cornea
- A matching donor cornea is placed in the opening
- The new cornea is stitched into place with fine sutures
In some cases, if a donor cornea is not suitable, an artificial cornea (keratoprosthesis) may be used.
Partial Corneal Transplant Procedures
In some cases, only certain layers of the cornea are replaced:
Endothelial Keratoplasty (EK)
Removes diseased tissue from the inner layers of the cornea.
Types include:
- DSEK: replaces about one-third of the cornea
- DMEK: uses a thinner donor layer and is more delicate and advanced
Anterior Lamellar Keratoplasty (ALK)
Removes damaged tissue from the outer layers of the cornea while preserving inner layers.
Types include:
- SALK: replaces only superficial layers
- DALK: replaces deeper layers without affecting inner structures
After Surgery
After the procedure, you can expect:
- Use of medications (eye drops and sometimes oral medications) to prevent infection and control swelling
- Wearing an eye patch to protect the eye during healing
- Avoiding injury to the eye and gradually returning to normal activities
- Regular follow-up visits, especially during the first year
Results
Most patients regain at least partial vision after corneal transplant. Results depend on the underlying condition and overall health.
The risk of complications or rejection can remain for years, so regular eye check-ups are necessary.
Vision Correction After Surgery
Vision may initially worsen as the eye adjusts to the new cornea. Improvement may take several months.
After healing, vision can be improved through:
- Correction of astigmatism caused by sutures
- Glasses or contact lenses
- Laser eye surgery in some cases