Corneal transplant techniques
A corneal transplant (keratoplasty) replaces damaged or diseased cornea with healthy donor tissue. In Australia, donor corneas are supplied through eye banks following donation. The most important change in recent decades is that surgeons can now often replace only the layer that is diseased rather than the whole thickness of the cornea.
Why a transplant may be needed
- Keratoconus that has progressed or scarred
- Fuchs dystrophy and other conditions of the inner corneal layer (see Managing Fuchs dystrophy)
- Corneal scarring after infection, injury or previous surgery
- Failure of an earlier graft
- Swelling of the cornea after eye surgery
The main techniques
Penetrating keratoplasty (PK) replaces the full thickness of the cornea. It is still the right choice when all layers are affected, such as in deep scarring. Healing takes longer, stitches often stay in for a year or more, and the shape of the cornea can take time to settle.
Deep anterior lamellar keratoplasty (DALK) replaces the front and middle layers while keeping the patient’s own endothelium. It is used mainly for keratoconus and scarring when the inner layer is healthy. Because the patient’s own inner layer is kept, the risk of rejection is lower than with a full-thickness graft.
Endothelial keratoplasty (DMEK and DSAEK) replaces only the innermost layer. It is used for Fuchs dystrophy and similar conditions. It uses few or no stitches and recovery is usually faster, with vision often improving over weeks to months.
Some conditions may be treated without a donor graft, or with other approaches. Your specialist will explain whether you are a candidate. Dr Abell performs all corneal transplant techniques.
What to expect
- Detailed assessment and discussion of the right technique
- Surgery under local or general anaesthetic, usually as a day procedure
- Strict use of drops, including anti-rejection drops, often for many months or longer
- Regular follow-up, and sometimes lying flat for a period after endothelial surgery
Rejection and other risks
The body can sometimes recognise a graft as foreign. Rejection is treated with steroid drops and is often reversible if caught early. Warning signs include redness, sensitivity to light, blurred vision and pain. If you have had a transplant and notice any of these, contact your eye specialist the same day. Other risks include infection, raised eye pressure, graft failure, cataract, astigmatism and the need for further surgery.
When to ask about referral
Consider referral if vision is limited by a corneal condition despite glasses or contact lenses, or if you have been told that your cornea is scarred, swollen or thinning.
This article is general information and is not a substitute for individual medical advice. All surgical and invasive procedures carry risks.
