Corneal transplant (graft) surgery

• Penetrating Keratoplasty (PK)

This is where the full thickness of the diseased cornea is replaced by the full thickness of a donor cornea and sutured into place. Recovery of vision often takes 1-2 years, when sutures need to be removed, and glasses or contact lenses may be required to obtain adequate vision.

• Descemet’s Stripping Endothelial Keratoplasty (DSEK) or Descemet’s Stripping Automated Endothelial Keratoplasty (DSAEK)

This is where a thin layer of donor cornea is inserted into the patient’s eye, and is made to stick to the back of the diseased cornea with the help of an air bubble. Recovery takes about 3-6 months, and the vision can improve greatly if the eye is otherwise healthy.

• Descemet’s Membrane Endothelial Keratoplasty (DMEK)

This is similar to a DSEK, but the layer of donor cornea which is inserted is extremely thin, which has the advantage of enabling more rapid recovery of vision (often 1-2 months), better vision, and a reduced risk of rejection.

Where an air bubble is used to position the corneal graft (in DSEK, DSAEK and DMEK), the patient will usually need to lay flat, looking at the ceiling for several hours after the operation. This ensures that the graft remains in place permanently. The air bubble will disappear within 3 days, but flying is not permitted for at least one week. If the graft dislodges, it may be necessary to re-inject air into the eye, and this is usually done within the first few weeks after the operation.

Eye drops are often continued indefinitely in patients receiving a corneal transplant to prevent graft rejection, and this will be adjusted by your surgeon. Regular post-operative reviews with your surgeon will be required into the long term to ensure the graft remains healthy. More than 70% of grafts will last longer than 3 years, with some grafts lasting over 30 years, depending on the patient’s specific disease and risk factors. Repeat corneal graft surgery may be required if the graft fails and the vision deteriorates again.

Some patients with limited Fuchs’ Endothelial Corneal Dystrophy (FECD) may be suitable for Descemet’s Stripping Only (DSO), also called Descemetorhexis Without Endothelial Keratoplasty (DWEK) surgery, in the absence of corneal transplantation. This involves removing the affected central endothelium and allowing the healthier cells on the periphery of the corneal endothelium to migrate inwards without the need for corneal transplantation.