Keratoplastik

Keratoplastik, or corneal transplantation, is a surgical procedure to replace diseased or damaged corneal tissue with healthy donor tissue to restore or improve vision, reduce pain, or treat corneal edema. It includes full-thickness and partial-thickness techniques.

The classic method is penetrating keratoplasty (PKP), a full-thickness graft. Partial-thickness approaches include deep anterior lamellar keratoplasty (DALK) for anterior diseases, and lamellar keratoplasty for posterior disease. Endothelial keratoplasty, such as Descemet's stripping automated endothelial keratoplasty (DSAEK) and Descemet membrane endothelial keratoplasty (DMEK), replaces only the innermost layers when the corneal endothelium is the problem.

Indications include corneal scarring from trauma or infection, keratoconus with scarring, corneal dystrophies, and endothelial failure from Fuchs' endothelial corneal dystrophy or bullous keratopathy, as well as pain from intractable edema. Selection depends on the location and depth of pathology.

Donor tissue is obtained through eye banks and prepared for transplantation; tissue compatibility is less restrictive than other transplants, with no major HLA matching required. The operation involves removing recipient tissue and placing donor tissue with sutures or adhesives, with specific techniques depending on the type. Postoperative care relies on immunosuppressive eye drops and close follow-up.

Visual recovery occurs over weeks to months; refractive changes may require glasses or contact lenses; graft rejection or failure can occur, requiring treatment or repeat transplantation. Modern endothelial keratoplasty offers faster recovery and better visual outcomes for endothelial diseases.