Has your doctor recommended a corneal transplant? Here we break down everything you need to know before you have a corneal graft – so you understand what to expect.
What does the cornea do?
The cornea is the clear, protective outer layer of the eye where light enters the eye.1 For this reason, it is often called the ‘window of the eye’.1
If the cornea becomes damaged due to a disease or injury, it can become cloudy, which significantly reduces vision.
Conditions that can cause corneal damage and may require corneal transplantation include:2
- Keratoconus
- Corneal ulcer, injury or infection (e.g. herpes keratitis)
- Conditions that cause corneal swelling and clouding (e.g. Fuchs’ Dystrophy)
- Chemical burns or direct eye injuries.
What is a corneal transplant?
A corneal transplant – also called corneal grafting or keratoplasty – is a surgical procedure in which a damaged or diseased cornea is replaced with a donated healthy cornea. By replacing the damaged cornea, corneal grafting aims to restore your vision.
What are the types of corneal transplant?
There are two types of corneal transplantation: full-thickness corneal grafts and partial-thickness corneal grafts.
Full-thickness corneal transplantation
A full-thickness corneal graft (also known as penetrating keratoplasty) involves the surgical removal of a button-shaped, full-thickness section of the cornea (includes all layers), which is then replaced with a healthy, donor cornea. The donor cornea is carefully placed and stitched into position.2
Partial-thickness corneal transplantation
A partial-thickness corneal graft is recommended when only some layers of the cornea are damaged. The surgeon only removes the damaged corneal layers and does not cut through the entire cornea.
Next, these specific layers are replaced with healthy layers from a donor cornea.
There are two types of partial-thickness corneal graft:3,4
- Deep anterior lamellar transplant – only the front and middle layers of the cornea are removed, and the two deeper layers are preserved; this surgery is often used to treat conditions like keratoconus and keratitis that damage the external corneal layers
- Endothelial layer transplant (endothelial keratoplasty) – the deepest layer of the cornea is removed, and the front layers are preserved; this surgery is commonly performed to treat Fuchs’ Dystrophy.
When do you need a corneal transplant?
Corneal replacements are usually recommended as a last-line solution when all other treatments have been exhausted. Your doctor will likely have trialled various other treatments prior to suggesting corneal transplantation.
What are the risks and benefits of a corneal transplant?
- Most people experience substantial vision improvements after corneal transplantation, although glasses or contact lenses may still be required.
- Corneal transplants are one of the most common transplant surgeries and have high success rates – after one year, around 90% of Australians who undergo this procedure have a working corneal graft.
- Although corneal replacements have a high success rate, there is a risk that the body’s immune system will reject the donor cornea and try to destroy it – this may require additional medications to calm the immune system, or a repeat transplant.
- Rarely, some people experience complications after surgery, such as infection, corneal swelling and bleeding. You can help avoid these complications by following your doctor’s post-surgery recommendations.
How long do corneal transplants last?
Generally, corneal grafts are successful and effectively restore vision for a minimum of 10 years.6
Like any transplant surgery, though, the success of a corneal replacement is not guaranteed, and it may not last for your lifetime. Further corneal disease, infection, and rejection of the donor cornea by the body can all affect corneal graft success.7
You can help to minimise the risk of complications like these by communicating any new symptoms immediately to your doctor, as this will enable timely treatment.
How long does it take to recover from a corneal transplant?
Recovery from corneal transplantation varies depending on the type of corneal replacement performed and the individual person.
Typically, you can leave the hospital the same day as your corneal graft, with eye drops to use and a post-operative appointment booked for the next day.
Over the following months, you will have regular appointments with your ophthalmologist. During these appointments, your ophthalmologist will monitor your recovery and may prescribe additional medications to prevent or treat swelling, infection or pain.
What is your vision like after a corneal transplant?
Visual recovery tends to be significant for most patients after corneal transplantation. However, visual improvements can be slow as it takes time for the donor cornea to heal and adhere to the eye.7
Usually, your vision can take up to a year to fully recover after full-thickness corneal grafts, while partial-thickness grafts are associated with faster recovery times.3
Are there artificial corneal transplant options?
Currently, there is ongoing global research to develop artificial corneas for transplantation. Artificial corneas may offer a treatment solution for patients who have previously rejected a human donor cornea, as well as reducing waitlists for corneal replacements worldwide.
Vision Eye Institute’s Professor Gerard Sutton is leading this research at the BIENCO consortium, where he and his team have developed world-first technology to bioengineer corneas. Prof Sutton recently received a $35 million grant from the Australian Government to manufacture these bioengineered corneas for global distribution. This has the potential to restore sight to millions of people all over the world.
Other useful links
More information about corneal transplantation
Prof Gerard Sutton’s record research grant for bioengineered cornea production
References
- Better Health Channel. Corneal transplantation and donation [Internet]. Melbourne (VIC): State of Victoria; [date unknown] [updated 2023; cited 2024 Aug 20]. Available from: https://www.betterhealth.vic.gov.au/health/ConditionsAndTreatments/corneal-transplantation-and-donation ↩ ↩ ↩
- Boxer Wachler. Cornea transplants: What to expect from keratoplasty [Internet]. Irving (Texas): All About Vision; [date unknown] [updated 2019; cited 2024 Aug 20]. Available from: https://www.allaboutvision.com/conditions/cornea-transplant.htm ↩ ↩
- Kiersten Boyd. About Corneal Transplantation [internet]. American Academy of Ophthalmology; [2023 Nov 21][cited 2024 Aug 20]. Available: https://www.aao.org/eye-health/treatments/about-corneal-transplantation ↩ ↩ ↩
- Fernandez et al. Endothelial keratoplasty: from DLEK to DMEK. Middle East Afr H Ophthalmol. 2010 Jan-Mar;17(1):5–8. doi: 10.4103/0974-9233.61210 ↩
- Brahma et al. Visual function after penetrating keratoplasty for keratoconus: a prospective longitudinal evaluation. Br J Ophthalmol. 2000 Jan;84(1):60-6. doi: 10.1136/bjo.84.1.60 ↩
- Boynton et al. Evolving techniques in corneal transplantation. Curr Surg Rep. 2015 Feb 1; 3(2): http://link.springer.com/article/10.1007/s40137-014-0079-5/fulltext.html ↩ ↩ ↩
- National Health Service. Corneal transplant [internet]. [date unknown] [updated 2021; cited 2024 Aug 20]. Available: https://www.nhs.uk/conditions/cornea-transplant/#:~:text=A%20cornea%20transplant%20is%20an,treat%20severe%20infection%20or%20damage ↩ ↩
The information on this page is general in nature. All medical and surgical procedures have potential benefits and risks. Consult your doctor for specific medical advice.