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The mission of the American Academy of Ophthalmology is to protect sight and empower lives by serving as an advocate for patients and the public, leading ophthalmic education, and advancing the profession of ophthalmology
Episode number: 
1510

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A healthy cornea is a key to good vision.  If your cornea is damaged by disease, infection, or an injury, the resulting scars can dramatically affect your vision. 

Source: American Academy of Opthalmology

About Corneal Transplant

The cornea is the clear, front window of the eye. It helps focus light into the eye so that you can see. The cornea is made of layers of cells. These layers work together to protect your eye and provide clear vision.

Your cornea must be clear, smooth and healthy for good vision. If it is scarred, swollen, or damaged, light is not focused properly into the eye. As a result, your vision is blurry or you see glare.

If your cornea cannot be healed or repaired, your ophthalmologist may recommend a corneal transplant. This is when the diseased cornea is replaced with a clear, healthy cornea from a human donor.

A human donor is someone who chooses to donate (give) his or her corneas after their death to people who need them. All donated corneas are carefully tested to make sure they are healthy and safe to use.

There are different types of corneal transplants. In some cases, only the front and middle layers of the cornea are replaced. In others, only the inner layer is removed. Sometimes, the entire cornea needs to be replaced.

What Causes Cornea Problems?

Eye disease and injuries can damage the cornea. Here are some common eye problems that can lead to a damaged cornea:

  • Keratoconus, where the cornea is coneshaped rather than dome-shaped
  • Fuchs’ dystrophy, where cells in the inner layer of the cornea are not working effectively
  • Eye infections or injuries that scar the cornea
  • Previous corneal surgery or other eye surgery that damaged the cornea

Corneal Transplant Options

Full thickness corneal transplant

Your entire cornea may need to be replaced if both the front and inner corneal layers are damaged. This is called penetrating keratoplasty (PK), or full thickness corneal transplant. Your diseased or damaged cornea is removed. Then the clear donor cornea is sewn into place.

PK has a longer recovery period than other types of corneal transplants. Getting complete vision back after PK may take up to 1 year or longer.

With a PK, there is a slightly higher risk than with other types of corneal transplants that the cornea will be rejected. This is when the body’s immune system attacks the new cornea tissue.

Partial thickness corneal transplant

Sometimes the front and middle layers of the cornea are damaged. In this case, only those layers are removed. The endothelial layer, or the thin back layer, is kept in place. This transplant is called deep anterior lamellar keratoplasty (DALK) or partial thickness corneal transplant. DALK is commonly used to treat keratoconus or bulging of the cornea.

Healing time after DALK is shorter than after a full corneal transplant. There is also less risk of having the new cornea rejected.

Endothelial keratoplasty

In some eye conditions, the innermost layer of the cornea called the “endothelium” is damaged. This causes the cornea to swell, affecting your vision. Endothelial keratoplasty is a surgery to replace this layer of the cornea with healthy donor tissue. It is known as a partial transplant since only this inner layer of tissue is replaced.

There are a few types of endothelial keratoplasty. They are known as:

  • DSEK (or DSAEK) — Descemet's Stripping (Automated) Endothelial Keratoplasty
  • DMEK — Descemet's Membrane Endothelial Keratoplasty

Each type removes damaged cells from an inner layer of the cornea called Descemet’s membrane. The damaged corneal layer is removed through a small incision. Then the new tissue is put in place. Just a few stitches—if any—are needed to close the incision. Much of the cornea is left untouched. This lowers the risk of having the new cornea cells being rejected after surgery.

Some things to know:

  • With DSEK/DSAEK surgery, the donor tissue may be easier to transplant and position because it is thicker than the donor tissue in DMEK surgery.
  • In DMEK surgery, the donor tissue is thin and can be more difficult to transplant. But, the recovery is quicker because the transplant tissue is thinner.
  • Your eye surgeon will choose the type of surgery based on your cornea’s condition.

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