About Corneal Transplant
A corneal transplant (keratoplasty) is surgery in which a cornea that has lost its transparency or structural integrity is replaced with healthy donated donor tissue. The aim is to restore the transparency of the cornea and, with it, vision.
In modern corneal surgery the entire cornea is no longer replaced in every case. Whichever layer of the cornea the disease affects, only that layer can be replaced. These layered (lamellar) methods preserve healthy tissue, providing faster recovery and a lower risk of rejection.
For the general surgery and follow-up of corneal diseases you can review our Corneal Surgery page, and for pre-transplant options in keratoconus our Keratoconus Treatment page.
Who Is It For and When Is It Used?
A corneal transplant comes onto the agenda in conditions where the cornea is permanently damaged:
- Advanced keratoconus: In a severely thinned/steepened cornea where cross-linking and lenses no longer give adequate results.
- Fuchs endothelial dystrophy: When the inner (endothelial) layer of the cornea fails and the cornea swells (DMEK/DSAEK).
- Bullous keratopathy: In endothelial failure and persistent corneal oedema, usually following previous surgery.
- Corneal scarring and clouding: In permanent corneal opacities that impair vision after infection or trauma.
- Failed previous transplant: In renewing a transplant that has been rejected or has lost its function.
Which layer is affected is determined with tests such as corneal topography and endothelial cell count.
Corneal Transplant Methods
Three main methods stand out according to the layer the disease affects:
- Penetrating Keratoplasty (PKP): The classic method in which the cornea is replaced full-thickness (all layers); preferred in wide and deep damage and advanced scarring.
- DALK (Deep Anterior Lamellar Keratoplasty): A method in which only the front and middle layers of the cornea are replaced and the patient’s own healthy inner layer (endothelium) is preserved; preferred especially in keratoconus when the endothelium is healthy.
- DMEK (Descemet Membrane Endothelial Keratoplasty): An advanced method in which only the thinnest inner layer of the cornea (Descemet membrane and endothelium) is replaced, providing rapid visual recovery in Fuchs dystrophy and endothelial failure.
- DSAEK: An alternative lamellar method used in endothelial disease that involves transplanting a thicker posterior layer than DMEK.
In suitable cases, lamellar methods (DALK, DMEK, DSAEK) offer faster recovery and a lower risk of rejection compared with penetrating keratoplasty.
Transplant Methods
Penetrating Keratoplasty
The classic transplant in which all layers of the cornea are replaced, used in advanced scarring and deep damage.
Planning
The depth of damage and the suitable method are determined.
Transplant
The diseased full-thickness cornea is removed and healthy tissue is sutured in.
Monitoring
Transparency is restored with suture and drop monitoring.
Restoring Transparency
DALK & DMEK
Modern, fast-healing methods in which only the diseased layer is replaced while healthy tissue is preserved.
Analysis
The affected layer is identified with endothelial cell count and topography.
Application
In DALK the front layer is replaced, in DMEK the thin inner layer.
Outcome
Healthy layers are preserved and visual recovery is faster.
Low Rejection, Fast Recovery
Which transplant method is right for you?
The method is decided together based on the affected layer and your corneal findings.
Benefits & Aftercare
Benefits of Lamellar Transplant
Methods such as DALK and DMEK preserve healthy tissue, providing safer and faster recovery.
- Preservation of healthy layers
- Faster visual recovery
- Lower risk of rejection
Aftercare & Follow-up
After transplant, drop therapy and regular follow-up are an important part of success.
- Regular drop and suture checks
- Protection against infection
- Long-term transparency and rejection monitoring