keratoplasty

Keratoplasty, also known as corneal transplantation, is a surgical procedure in which all or part of the cornea is replaced with donor tissue. The operation is performed to restore vision damaged by corneal disease, remove scarring, or repair significant corneal injury. Over time, several techniques have been developed to address different layers of the cornea.

Types of keratoplasty include penetrating keratoplasty (PK), which replaces the full thickness of the cornea; lamellar keratoplasty, which replaces only selected layers and preserves others. Lamellar options include deep anterior lamellar keratoplasty (DALK) and anterior lamellar keratoplasty for anterior corneal disease. Endothelial keratoplasty (EK) replaces only the innermost endothelial layer and Descemet’s membrane, with variants such as DSEK/DSAEK and Descemet’s membrane endothelial keratoplasty (DMEK). Endothelial procedures often offer faster recovery and less induced astigmatism compared with PK, particularly for endothelial failure.

Indications for keratoplasty include corneal opacities or scars that impair vision, keratoconus with scarring or thinning, endothelial dysfunction such as Fuchs’ dystrophy or bullous keratopathy, corneal dystrophies, infectious keratitis, trauma, and failed prior grafts.

Donor tissue is provided by eye banks and matched by quality and size. The procedure typically involves trephination of donor and recipient areas and suturing the graft in place, with suture strategies varying by technique. Postoperative care centers on topical corticosteroids and antibiotics, along with regular follow-up to monitor graft clarity and intraocular pressure; vision often improves gradually over weeks to months.

The first successful corneal transplant was performed in 1905. Since then, refinements in lamellar and endothelial techniques have improved safety, recovery, and graft survival for many patients.