Cornea Transplant (Keratoplasty)

What is Cornea Transplant Surgery?

Cornea Transplant Surgery (Keratoplasty) is an advanced tissue transplantation procedure in which damaged, opaque, or ectatic corneal tissue is surgically removed and replaced with a healthy, clear donor cornea obtained from an eye bank. The cornea is the eye's clear front window responsible for focusing light; replacing a scarred cornea restores optical transparency and eliminates structural discomfort.

Who Needs Cornea Transplant Surgery?

Transplant is indicated when corneal clouding, thinning, or irregularity severely reduces visual function or causes persistent pain unresponsive to conservative medical therapy.

Key clinical indicators include:

• Advanced Keratoconus with progressive corneal thinning and steep cone-like bulging.
• Corneal scarring resulting from trauma, severe infections (herpetic, fungal, bacterial keratitis).
• Corneal decompensation or Pseudophakic Bullous Keratopathy (PBK) following complex cataract surgery.
• Fuchs' Endothelial Dystrophy causing chronic corneal swelling and loss of clarity.
• Graft failure following a previous corneal transplant.

Types of Corneal Transplants

• Penetrating Keratoplasty (PK): Full-thickness transplant where all layers of the damaged central cornea are replaced with donor tissue.
• Deep Anterior Lamellar Keratoplasty (DALK): Selective partial-thickness transplant replacing only the outer corneal layers (epithelium and stroma) while retaining the patient's healthy endothelium.
• Descemet's Stripping Endothelial Keratoplasty (DSEK / DMEK): Selective micro-transplant replacing only the innermost diseased endothelial cell layer through a small keyhole incision.
• Femtosecond Laser-Assisted Keratoplasty (FLAK): High-precision laser-cut shaped graft (e.g., zig-zag or mushroom cut) for superior alignment and faster wound strength.

Benefits of Cornea Transplant Surgery

1. Permanent restoration of corneal clarity and significant visual recovery.
2. Relief from chronic eye pain, photophobia, and surface irritation caused by corneal blisters.
3. Preservation of structural integrity of the eyeball.
4. Selective layer transplants (DSAEK/DMEK) offer ultra-fast visual rehabilitation.

What to Expect Before Surgery?

Detailed testing and donor tissue screening are carried out prior to scheduling:

• Specular Microscopy: Counting donor corneal endothelial cell density (must exceed 2000-2500 cells/mm²).
• Corneal Pachymetry & Topography: Measuring corneal thickness profiles and structural maps.
• Infection Screening: Complete viral and bacterial screening of certified donor tissue.
• Pre-Op Anti-Rejection Planning: Medical clearance and preoperative steroid drop initiation.

Complete Procedure

The surgical sequence for Endothelial Keratoplasty (DMEK/DSAEK) involves:

1. Administering regional block or general anesthesia to ensure complete immobility.
2. Making a tiny micro-incision at the sclero-corneal junction.
3. Stripping away the diseased host endothelial membrane (Descemetorhexis).
4. Preparing the ultra-thin donor endothelial graft disc.
5. Injecting the donor tissue graft into the patient's anterior chamber.
6. Unfolding the graft disc and floating an air or gas bubble beneath it to press it against the host cornea.
7. Confirming graft adhesion and securing micro-incisions.

What to Expect During Surgery?

Surgery duration ranges from 1 hour (for endothelial layer transplants) to 2 hours (for full-thickness PK). You will feel no pain under local or general anesthesia.

Full-Thickness (PK) vs Selective Layer (DALK / DMEK)

Success Rate and Safety

Corneal transplantation is the most successful organ/tissue transplant procedure in human medicine, with 1-year graft survival rates exceeding 90% for primary clear grafts.

Cornea Transplant Surgery Cost Estimate

Disclaimer: Cost varies based on eye bank donor tissue processing fees, surgical technique, hospital stay, and post-op medication.

Recovery Guide & Post-Operative Care

Recovery Timeline

• Week 1-2: Face-up posturing if gas bubble used (DMEK); progressive clearing of corneal haze.
• Month 1-3: Stitches checked; rapid vision improvement for DSAEK/DMEK.
• Month 6-12: Selective stitch removal for full-thickness PK; final glass/contact lens prescription.

Post-Op Precautions & Care

• Steroid Drop Adherence: Immunosuppressive steroid eye drops must be used continuously as prescribed (sometimes long-term) to prevent graft rejection.
• Eye Shield: Rigid eye shield must be worn sleep time for at least 1 month.
• No Eye Rubbing: Strict avoidance of pressure or rubbing on the eye.
• Rejection Warning Signs (RSVP): Contact doctor immediately if experiencing Redness, Sensitivity to light, Vision drop, or Pain.