The cornea is the clear outer lens at the front of the eye. A corneal transplant (keratoplasty) is surgery to replace the cornea with tissue from a donor and is one of the most common transplants performed.

A cornea transplant can restore sight, reduce pain, and improve the appearance of a cornea that is damaged or affected by disease. With a corneal transplant, a number of conditions can be treated, including:

• A cornea that grows outward (keratoconus).
• Fuchs’ dystrophy, an inherited disease.
• Thinning or tearing of the cornea.
• Corneal scars, caused by infection or injury.
• Swelling of the cornea
• Corneal ulcers that do not respond to medical treatment.
• Complications caused by previous eye surgery.

How is Cornea Transplant Surgery?

First, the tissue for the corneal transplant will come from a donor person (recently deceased). The donated cornea is processed and analyzed at a local eye bank to verify that it is safe for use in surgery.

For surgery, local anesthesia is applied around the eye to prevent eye movement and block pain during surgery. The patient remains awake during the surgery, but is given medication to relax him.

The surgery is done on one eye at a time. The amount of time you spend in surgery is different and depends on your situation.

There are different types of procedures, which the surgeon will decide which of these methods should be used:

Penetrating keratoplasty

It is a full-thickness corneal transplant. It consists of cutting the entire thickness of the abnormal or disease-affected cornea to remove a small disk of tissue from the cornea. A special instrument is used to make this precise circular cut and the donor cornea is subsequently cut to match the opening. The surgeon then uses stitches (sutures) to sew the new cornea in place. The stitches may be removed at a later visit to your ophthalmologist.

Endothelial Keratoplasty

These procedures remove disease-affected tissue from the posterior layers of the cornea, including the endothelium and a thin layer of tissue that protects the endothelium from injury and infection (Descemet’s membrane). Donor tissue replaces the removed tissue.

There are two types of Endothelial Keratoplasty: Endothelial Keratoplasty with Descemet’s Membrane Resection and Descemet’s Membrane Endothelial Keratoplasty.

Endothelial Keratoplasty with Descemet’s Membrane Resection: Donor tissue is used to replace about one-third of the cornea.

Descemet’s Membrane Endothelial Keratoplasty: A much thinner layer of tissue from a donor is used. The tissue used in this procedure is extremely thin and fragile. This procedure is more complex than endothelial keratoplasty with Descemet’s membrane resection and is not used as frequently.

Anterior Lamellar Keratoplasty

Two different methods remove disease-affected tissue from the front layers of the cornea, including the epithelium and stroma, but leave the posterior endothelial layer in place. The depth of corneal damage determines the type of procedure is right for you.

With the Superficial Anterior Lamellar Transplant procedure, only the front layers of the cornea are replaced, leaving the healthy stroma and endothelium intact.
The Deep Anterior Lamellar Transplant Procedure is used when damage to the cornea extends deep into the stroma. Healthy tissue from a donor is then attached (grafted) to replace the removed part.
Artificial corneal transplant (keratoprosthesis).

In some cases, if the patient is not eligible for a corneal transplant from a corneal donor, they may receive an artificial cornea (keratoprosthesis).

Your doctor will explain which method of surgery is right for you, what to expect during the procedure, and what the risks of the procedure are.

What are the risks?

One of the risks is that the body may reject the transplanted tissue. This occurs in about 1 in 3 patients in the first 5 years, and rejection can sometimes be controlled with steroid eye drops.

Other risks for corneal transplantation are:

Bleeding
waterfalls
Eye infection
Glaucoma (high pressure in the eye that can cause vision loss)
Sight loss
Scarring of the eye
Inflammation of the cornea
Before

Before your corneal transplant surgery, you will:

A thorough eye exam to look for conditions that could cause complications after surgery.
Eye measurements to determine the size of the donor cornea you need.