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Corneal Transplant Surgery
Corneal transplant surgery, also known as corneal grafting or keratoplasty, replaces a damaged, scarred or diseased cornea – the clear front window of the eye – with healthy donor tissue. This life-changing procedure restores clearer vision for conditions like advanced keratoconus, corneal scars from injury or infection, Fuchs’ dystrophy, or swelling that doesn’t respond to other treatments. While recovery takes time and patience, success rates are high (around 90% vision improvement), and modern techniques make it safer than ever.
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What is a corneal transplant?
The cornea is the transparent dome at the front of the eye that lets light in and focuses it sharply on the retina. When it’s scarred, swollen, thinned or clouded, vision becomes blurry, distorted or hazy – like looking through a dirty window.
In a corneal transplant:
- A surgeon removes the damaged central cornea (usually 7-8 mm across).
- Healthy cornea from a donor (someone who generously donated their eyes after death) is precisely cut to fit and sewn in place with tiny, hair-thin stitches.
- Donor tissue is rigorously screened for safety and stored by eye banks until needed – often within days. It’s not rejected like some organ transplants because the cornea has few blood vessels.
Types of corneal transplants
Not all transplants replace the full cornea thickness. Your surgeon chooses based on your condition:
Endothelial transplants (like DMEK) are increasingly popular as they preserve more healthy tissue and heal quicker.
Why might you need one?
Common reasons include:
- Keratoconus: Cone-shaped cornea too advanced for lenses or cross-linking.
- Scarring: From injury, infection (e.g., herpes), ulcers or surgery complications.
- Fuchs’ dystrophy: Age-related inner layer failure causing swelling and blur.
- Failed previous graft or bullous keratopathy (painful blisters).
You’re assessed with corneal scans (topography/pachymetry), vision tests and health checks to confirm it’s the best option.
Preparing for surgery
Expect:
- Thorough eye exam, measurements for donor size, blood tests and medical review.
- Stop certain meds/supplements; treat infections first.
- Arrange a driver – day surgery, no overnight stay usually.
- Fast 6 hours pre-op; bring drops/meds.
Local anaesthetic (eye drops/injection) + sedative keeps you relaxed; general anaesthetic rare.
The procedure
Takes 1-2 hours:
- Eye numbed; speculum holds lids open. A general anaesthetic is usually required for a full thickness transplant.
- Microscope-guided: trephine (cutter) removes damaged cornea.
- Donor cornea fitted, sewn with 16-24 stitches (finer than hair).
- Shield/pad applied; recovery room monitoring.
For DSAEK/DMEK: thinner graft “unscrolls” inside; air bubble holds it (lie flat 1-24 hours).
Recovery timeline
- Healing is gradual – full vision stabilisation 6-18 months.
- Day 1: Gritty/watery/red; blurry. Rest, drops start.
- Week 1: Review next day; shield/glasses. No rubbing/swimming.
- Month 1-3: Stitches tighten cornea; frequent checks. Light work OK.
- 6-12 months: Stitches removed/adjusted; new glasses Rx.
- 1+ year: Final vision; lifelong drops/checks.
Drops: Antibiotic 1-2 weeks, steroid 3-12+ months (wean slowly). Paracetamol for discomfort.
Do’s: Wash hands, drops on schedule, sunglasses, light exercise after 2 weeks.
Don’ts (1 month): Heavy lifting, straining, dusty areas, contact sports. Long-term: No eye trauma.
Vision outcomes
- 90% see better; many drive/read with glasses/contacts
- Full grafts: Glasses for astigmatism (stitches tuned)
- Partial: Often sharper, quicker spectacle independence
- Factors: Original disease, age, compliance
Risks and complications
Low but possible (5-20%):
- Rejection (1-20%; urgent steroids if redness/pain)
- Infection, bleeding, high pressure
- Graft detachment (DSAEK; re-bubble)
- Suture issues, astigmatism
- Lifelong monitoring is key
Living with your new cornea
Enjoy clearer vision for hobbies/work! Protect with UV glasses, no trauma. Annual checks forever. Gratitude to donors – many registries promote awareness.
Frequently Asked Questions
Is the donor cornea safe?
Yes. Donor corneas are carefully screened for infectious diseases, including HIV and hepatitis, and must meet strict safety standards. Corneal tissue is stored for at least 14 days before use, which adds an extra layer of safety.
Is the surgery painful?
The surgery itself is painless because your eye is fully numbed. Afterward, it’s normal to feel some grittiness, irritation, or discomfort. This is usually well controlled with eye drops and, if needed, pain-relief tablets.
When can I drive again?
Driving may be possible anywhere from 1 to 4 weeks after surgery, depending on how quickly your vision improves. Your ophthalmologist will let you know when it’s safe to drive.
What are the signs of graft rejection?
Sudden redness, increasing pain, light sensitivity, or a drop in vision can be warning signs of rejection. If you notice any of these, seek urgent eye care — early treatment is very effective.
Will I still need glasses after a corneal transplant?
Often, yes. Glasses are commonly needed to fine-tune vision after healing. Some patients with irregular astigmatism may achieve better vision with contact lenses.
What is the success rate of corneal transplantation?
Over 90% of patients experience meaningful improvement in vision or comfort. Many full-thickness corneal grafts last 10–20 years or longer, depending on the underlying condition and ongoing care.
When can I swim or play sports again?
Swimming should be avoided for at least the first month after surgery. Contact sports are generally discouraged long-term to protect the graft from injury.
Can both eyes be treated at the same time?
Corneal transplants are usually performed on one eye at a time. If the second eye needs surgery, it is typically done later once the first eye has healed.
When are the stitches removed?
Stitches are usually removed gradually between 6 and 18 months after surgery. This is done selectively to help optimise the shape of the cornea and improve vision.
Can I travel after surgery?
Flying is usually avoided for the first week. After that, travel is generally fine as long as you continue using your prescribed eye drops and attend follow-up appointments.