Corneal transplant

This page contains a summary of our information on corneal transplant. To read our full information, download our factsheet:

If your ophthalmologist has told you that you may need a corneal transplant, you will need corneal tissue from a donor.

Organ or tissue donation is when you decide to give an organ or tissue to save or transform the life of someone else. Most organ and tissue donations come from people who have died, like cornea donors.

Eye donation involves donating your corneas, not the whole eye. Even people who may be unable to donate their organs can usually become cornea donors. People who become cornea donors are helping to restore the sight of patients with a variety of eye conditions.

If your cornea is too scarred, damaged, or distorted for glasses or contact lenses to help, you might need a corneal transplant to see clearly again. A corneal transplant can also relieve pain or discomfort from severe infection or injuries that aren’t responding to other treatment.

Your ophthalmologist (hospital eye doctor) will talk to you about how a corneal transplant could improve your vision and when to have surgery. This will help you decide if you want to go ahead with it.

Surgery for a corneal transplant usually takes around one to two hours, depending on the type of transplant surgery. It can be done using local anaesthetic, where you are awake, or general anaesthetic, where you are unconscious and unaware.

I Local anaesthetic is given as an injection into the soft tissue around your eye, not into your eye itself. You will also be given anaesthetic eye drops to numb the front of the eye.

The injection stops you feeling pain from your eye, reduces what you can see and stops your eye from moving around. You will need to be able to lie still for the whole operation to be suitable for a local anaesthetic.

If you have a local anaesthetic, you might be offered sedation. This is a medication which makes you feel sleepy and relaxed during the surgery. Your doctor would be able to explore whether sedation would be right for you. Sedation can make the surgery less stressful and more comfortable for you.

Your eye should not be too painful following the surgery. If there is any discomfort you may be given painkillers such as paracetamol. You may find that you are sensitive to light and a pair of plain dark glasses should help. The sutures in your eye may initially make your eye feel gritty, but these should not be painful. If they are, it would be important to contact the hospital about this.

Following surgery your eye will be patched. You will be given a protective plastic eye shield to wear when sleeping for about two weeks after the operation. You can usually go home either the same day or next day. You will usually go back to the eye clinic within the first week to have your eye checked.

Your ophthalmologist may ask you to put in eye drops for six months or more after your operation. It is essential the eye drop treatment is continued exactly as instructed until the end of the course. This is very important because it helps prevent infection and rejection and allows the transplant to become part of your eye.

You will need to use steroid eye drops to prevent your immune system from rejecting the new donor corneal layers. You will probably need to use these for at least a year, and in some cases for life. If your ophthalmologist feels that there is a high risk of rejection, you might need to take other medicines to suppress your immune system.

After surgery you’ll been given antibiotic eye drops for a few weeks to prevent infection. You ophthalmologist will let you know how often you will need to use all these and for how long.

After the first week’s check-up, you would typically be seen again within a month and then every few months for the first year. Depending on the type of transplant you have, you may not need further appointments after the first one to two years. Some people who have had a corneal transplant will need life-long check-ups.

There are three types of corneal transplant.

• Endothelial Keratoplasty (EK) - removes and replaces the innermost layers of the cornea
• Deep Anterior Lamellar Keratoplasty (DALK) - removes and replaces part of the front layers of the cornea
• Penetrating Keratoplasty (PK) - removes and replaces all the layers of your cornea.
• Limbal Epithelial Stem cell transplant (LESCT) – this is a highly specialised type of corneal transplant. It involves transplanting corneal cells from stem cells. These stem cells are taken from a person's healthy eye, a living-related donor’s eye, or a deceased donor’s eye.

The type of transplant you will be offered depends on the layers or cells of your cornea that are affected.

Endothelial keratoplasty (EK)

EK replaces only the innermost layers of the cornea. It is therefore suitable for corneal dystrophies and conditions solely affecting the endothelial layer of the cornea, such as Fuchs endothelial dystrophy. EK surgery can be done under either local or general anaesthesia and takes about an hour.

There are two main types of EK transplants:

• Descemet's stripping endothelial keratoplasty (DSEK), also known as a 'DSAEK' where the 'A' stands for automated.

In DSEK you receive a replacement endothelium and Descemet's membrane, as well as some of the stroma from a donor cornea.

• Descemet's membrane endothelial keratoplasty (DMEK)

In DMEK you receive only the endothelium and Descemet's membrane from a donor cornea.

Descemet’s membrane endothelial keratoplasty (DMEK) is most commonly used. If the cornea is very hazy, your surgeon may offer you DSAEK.

Deep anterior lamellar keratoplasty (DALK)

In DALK surgery, the surgeon removes the corneal epithelium, Bowman’s membrane and stromal layers of the cornea from the centre of your cornea. Descemet’s membrane and the innermost endothelial layer are left in place.

Your ophthalmologist then places a specially prepared donor cornea ("button") containing stroma and epithelium onto your cornea. The donor button is cut so that it fits precisely into the area of your cornea which was removed. This donor cornea position is secured by tiny sutures until it heals in place.

DALK usually takes about a year to heal. Some stitches may be removed before this, but usually not before the first six months.

Penetrating keratoplasty (PK)

PK is a "full thickness" transplant. PK is likely to be offered if the stroma and endothelium of your cornea are damaged, for example in keratoconus. During PK your whole cornea is replaced by a donor cornea which is held in place with sutures. Corneal transplant sutures are made of nylon which is non-absorbable and provides long lasting good tensile strength in tissues. Sutures are usually left in place for a year or more following surgery.

Limbal Epithelial Stem cell transplant (LESCT)

The limbus is part of the epithelial layer of the eye. It contains special cells called limbal stem cells which protects the cornea. Sometimes, the body is no longer able to produce enough limbal stem cells. In some cases, it produces no limbal stem cells at all. This can be caused by an eye condition or chemical injury to the eye. This reduction in limbal stem cells is known as limbal stem cell deficiency and it can result in a loss of vision.

Limbal epithelial stem cell transplant (LESCT) aims to restore the healthy epithelium of the eye. Because of the complex nature of this treatment, patients are typically treated in a specialist centre within the NHS.

In LESCT, limbal stem cells are taken from a living or deceased donor and grown in the laboratory. They are then transplanted onto the patient’s affected eye(s). The transplant is carried out under local or general anaesthesia.

EK is "keyhole" surgery, which is quick to heal. Because a thinner layer of tissue is transplanted in DMEK, recovery times are faster than for DSAEK. The visual results are also better, and the rejection risk is lower. The rejection risk is one in 100 for DMEK, compared to seven to eight in 100 for DSAEK.

Sometimes, the donor layer can detach from the back of the cornea. This usually happens in the first days following an EK transplant. If this happens, you will need to have a small procedure to inject a further air bubble into the eye to help the transplanted tissue to reattach. This is known as "rebubbling". DMEK transplants need to be rebubbled slightly more often compared to DSAEK transplants. However, this is still only about two in 10 DMEK transplants, meaning eight out of 10 do not need rebubbling.

Both DALK and PK transplants work well. About nine out of 10 DALK and PK transplants carried out for keratoconus are functioning well after 10 years. Newer DALK transplants also seem to last longer and have an even lower risk of failing.

Although PK transplants are an effective treatment, five out of 10 are no longer working at 20 years. If you’re younger you might be advised to wait longer before having a corneal transplant, as you are more likely to require several transplants in your lifetime.

The risks of failure for PK and DALK are low for most corneal conditions, but after both types of surgery it can take a long time for vision to recover. You will need to wear glasses and sometimes contact lenses after the transplant to get the best possible vision.

Following a transplant, you will need to use steroid eye drops for at least one year, and in some cases indefinitely, to prevent rejection of the transplanted donor cornea.

Transplants also increase the risk of cataracts, the clouding of the lens in your eye, and glaucoma, where there is damage to the optic nerve due to eye pressure. These risks are partly due to the need for steroids following the surgery.

LESCT is as an option in people with moderate to severe corneal stem cell damage after chemical burns to the eyes. Early studies show that patients may remain stable up to 10 years following the surgery. Further clinical research is required to fully understand how well the procedure works.

Sometimes following corneal transplant surgery, your body’s immune system recognises the transplanted donor tissue as foreign tissue and starts to react against it. This is known as corneal transplant rejection. Rejection can occur a few weeks after a cornea transplant but is more common after several months. Corneal transplant rejection can occur at any time even many years after the transplant. Rejection episodes can usually be reversed if it is diagnosed and treated promptly.

It is usually possible to treat corneal transplant rejection with anti-inflammatory eye drops, such as corticosteroids. Corticosteroids work by reducing the activity of your immune system so that it no longer releases the chemicals which cause inflammation. You may require steroids in the form of eye drops or injections into the blood stream or tablets.

How common is corneal transplant rejection?

The risk of corneal transplant rejection varies depending on the type of transplant and whether there are any risk factors. This risk can be assessed by your ophthalmologist who will be familiar with your condition. Repeated problems with rejection can lead to the transplant failing and the need for repeat transplant surgery.

Being diagnosed with an eye condition can be very upsetting. You may find that you are worried about the future and how you will manage with a change in your vision. We’re here to support you every step of the way, and to answer any questions you may have – just get in touch with our Sight Loss Advice Service.