What it is
The cornea is the clear dome at the front of the eye. When it becomes cloudy, scarred or misshapen, keratoplasty replaces it with healthy corneal tissue from an eye donor. In a full-thickness transplant (penetrating keratoplasty, or PK) the whole central cornea is replaced. In partial-thickness transplants only the damaged layers are replaced: DALK (deep anterior lamellar keratoplasty) replaces the front and middle layers while keeping your own healthy inner layer, and endothelial keratoplasty — DMEK (Descemet membrane endothelial keratoplasty) or DSEK (Descemet stripping endothelial keratoplasty) — replaces only the damaged inner cell layer. Your surgeon decides which layers need replacing based on your corneal condition.
Who it's for
People with corneal scarring after infection or injury, advanced keratoconus (a thinning, cone-shaped cornea, usually treated with DALK), corneal swelling caused by damage to the inner cell layer — for example in Fuchs' endothelial dystrophy, usually treated with DMEK or DSEK — or a previous transplant that has failed. Suitability depends on which corneal layers are affected, overall eye health and visual potential.
What to expect
A pre-operative evaluation includes a visual acuity check, corneal examination and imaging to assess which layers are affected, eye pressure measurement, an examination of the retina and internal eye structures where possible, and a review of your medical history. Donor tissue comes from an eye bank, so the surgery date depends on its availability. The operation is done under local or general anaesthesia, and your doctor will explain which type of transplant is planned for your eye and why.
Recovery
Recovery is gradual. Vision can take several months, and sometimes a year or more after a full-thickness transplant, to settle. Stitches may stay in place for many months. You will use eye drops for a long time to help prevent rejection. Contact the hospital urgently if you notice redness, sensitivity to light, reduced vision or pain in the transplanted eye.
Frequently asked questions
What is graft rejection?
Rejection is when the body's immune system attacks the donor cornea. It can often be treated if caught early, so report redness, light sensitivity, reduced vision or pain straight away.
Where does the donor cornea come from?
From people who pledged to donate their eyes after death. The tissue is tested and provided through an eye bank.
Can I pledge to donate my eyes?
Yes. Anyone can pledge to donate their eyes, whatever their age or glasses power. Ask at the front desk for information.
Medically reviewed by Dr. Sweta Patro