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OUTLOOK EYE TREATMENTS

Corneal Transplantation

What is a corneal transplant?

A corneal transplant, also known as keratoplasty, is a surgical procedure where a damaged or diseased cornea is replaced with a healthy donor cornea. This procedure aims to restore vision and improve eye health when the cornea becomes cloudy or deformed.

Common Conditions Requiring Corneal Transplants:

Keratoconus: A condition where the cornea becomes thin and bulges into a cone shape.

Fuchs’ Corneal Endothelial Dystrophy: A condition that causes the cornea to swell and become cloudy.

Corneal scarring: Often from injury, infection, or previous eye surgery.

Bullous Keratopathy: A painful condition due to damaged corneal cells leading to fluid buildup.

What are the types of corneal transplant?

Corneal transplant surgery has undergone significant advances in the last 20 years and new surgical techniques have allow targeted transplantion to ensure the best results and quickest recovery. The type of transplant a patient will require depends on the nature of condition affecting their cornea.

The types of corneal transplants include:

Penetrating Keratoplasty (PK)

Penetrating keratoplasty is a full-thickness corneal transplant where the entire damaged cornea is replaced with a healthy donor cornea. It is used for severe corneal scarring or disease affecting the whole cornea. Read more about penetrating keratoplasty here.

Deep Anterior Lamellar Keratoplasty (DALK)

DALK is a partial-thickness corneal transplant that replaces only the front layers of the cornea. It is commonly used for conditions like keratoconus, preserving the inner layers of the cornea and often results in longer transplant survival. Read more about deep anterior lamellar keratoplasty here.

Descemet Membrane Endothelial Keratoplasty (DMEK)

DMEK is a specialized, extremely thin, partial-thickness corneal transplant that only replaces the damaged Descemet membrane and endothelial layer of the cornea. These are the very thin inner layers of the cornea. DMEK is typically used for conditions like Fuchs’ dystrophy and bullous keratopathy. Read more about DMEK here.

Descemet’s Stripping Automated Endothelial Keratoplasty (DSAEK)

DSAEK involves removing the damaged endothelial layer and replacing it with a donor tissue. This procedure is used for conditions affecting the inner cornea, such as Fuchs’ dystrophy or bullous keratopathy. It offers faster recovery than full-thickness transplants and is often required for more complex corneal diseases. Read more about DASEK here.

Corneal Allogenic Intrastromal Ring Segments (CAIRS)

CAIRS is a procedure where donor corneal ring segments are inserted into the stroma (middle layer) of the cornea to correct irregularly shaped corneas. It is often used for patients with keratoconus to improve vision and corneal shape. Read more about CAIRS here.

Frequently Asked Questions

Corneal transplantation is surgery that replaces a damaged, diseased, or scarred cornea with healthy donor tissue. Modern techniques allow selective replacement of only the specific corneal layer that is diseased, rather than the full corneal thickness, which significantly improves outcomes and reduces recovery time.
Donor corneal tissue is provided by the Eye Bank of Queensland. Tissue is screened for infectious diseases and assessed for quality before use. The donation and preparation of donor tissue is conducted with the highest clinical and ethical standards.
Conditions that may require corneal transplantation include Fuchs endothelial corneal dystrophy, advanced keratoconus, corneal scarring from infection or trauma, bullous keratopathy (corneal swelling following previous eye surgery), and failure of a previous corneal graft.
Outlook Eye Specialists perform endothelial keratoplasty (DSEK and DMEK) for conditions affecting the corneal endothelium such as Fuchs dystrophy, Deep Anterior Lamellar Keratoplasty (DALK) for keratoconus, and Penetrating Keratoplasty (PK) for full-thickness corneal disease. The most appropriate technique is selected based on which layers of the cornea are affected.
A penetrating keratoplasty (PK) replaces all layers of the cornea. Partial thickness transplants (such as DMEK, DSEK, and DALK) replace only the diseased layer. Partial thickness techniques offer faster visual recovery, lower rejection rates, and fewer complications compared to full-thickness transplants, and are now the preferred approach for most conditions.
Recovery time varies considerably depending on the type of transplant. DMEK patients often achieve good vision within 1–3 months. DSEK recovery typically takes 3–6 months. PK vision takes 12–24 months to fully stabilise, partly because sutures remain in place for 12–18 months. Long-term follow-up is required for all types of corneal graft.
Graft rejection occurs when the immune system recognises the donor tissue as foreign and mounts a response against it. It is more common with full-thickness grafts (PK) than with partial-thickness techniques. The risk is reduced, but not eliminated, with long-term topical steroid drops. Early recognition of rejection symptoms (sudden redness, pain, reduced vision, light sensitivity) and urgent treatment with steroid drops can usually reverse the rejection episode.
Corneal grafts can last for decades. DMEK grafts for Fuchs dystrophy have very good long-term survival. PK grafts have graft survival rates of approximately 90% at 5 years and 70–80% at 10 years, with rejection and graft failure being the main causes of late loss. Compliance with steroid drops and regular follow-up are essential to graft longevity.
Yes. Combining cataract surgery with corneal transplantation (known as a triple procedure) is common, particularly for patients with Fuchs dystrophy who also have a cataract. Performing both procedures together reduces the number of surgical episodes and can provide excellent visual outcomes. Your ophthalmologist will discuss whether a combined approach is appropriate for you.
Corneal transplantation attracts a Medicare rebate for the surgical procedure and the ophthalmologist’s fee. Hospital and anaesthetic fees also apply. Our team will provide a full cost breakdown at your pre-operative consultation.