You may need a corneal transplant (also keratoplasty or corneal graft) when you suffer damage to the clear layer on the front of the eye that sits directly before the pupil. Known as the cornea, this part of the eye helps to focus light for a clear, sharp image of the things you see. When it becomes damaged or changes shape, patients can experience vision loss, discomfort and unwanted aesthetic factors such as clouding or scarring.
Why would you need corneal transplant surgery?
Severe damage from scarring is a common reason to need a corneal transplant. At other times, thinning at the cornea can distort it to a point where the vision can no longer be improved with glasses or contact lenses.
Similarly, patients may need a corneal transplant to provide long-term relief from infections or injuries as a result of corneal dystrophies which cause damage to the eye once treatment is no longer effective. Instances include:
- Ulcers or sores on the cornea (from infection)
- Corneal abrasions (scratches on the eye’s cornea)
- Keratoconus (bulging at the cornea)
- A thinning or swollen cornea
- Inherited eye health problems
- Complications from surgery
What happens during corneal transplant surgery?
Corneal transplant or cornea transplant surgery involves the removal of all or part of the cornea and immediate replacement with healthy eye tissue from a donor.
Donated eye tissue comes from donors who have volunteered their healthy organs to be used in medicine and science after they die. The NHS organ donor card programme is an opt-in system offered to all UK citizens.
Depending on the type of corneal damage that the patient has endured prior to surgery, a different procedure may be appropriate. Variations include:
Deep anterior lamellar keratoplasty (DALK)
Deep anterior lamellar keratoplasty or DALK is appropriate for people with eye bulging from keratoconus or a superficial corneal scar that has not penetrated the deeper layers of the cornea.
Sometimes referred to as a partial thickness corneal transplant, DALK requires the surgeon to separate the thin outside layers of the cornea from the thicker layers in the middle. To do this, air must be injected into the cornea to hold the layers apart. From there, the surgeon removes and replaces the affected areas only. The new donated cornea is held in place with very fine stitches, finer than the width of a hair.
Penetrating keratoplasty (PK)
A penetrating keratoplasty (PK) will happen when all layers of the cornea have endured too much damage and must be replaced. The entire cornea is removed during this procedure and new tissue is stitched onto the eye using very fine fibres.
Endothelial Keratoplasty
When the most inner part of the cornea, the endothelium is affected, doctors recommend a Descemet's stripping endothelial keratoplasty (DSEK or DSAEK). To perform the surgery a doctor must remove the Descemet membrane, a middle part of the cornea, and the endothelium, an extremely thin one-cell-thick layer of the cornea below. Both parts are replaced as well as some of the stroma.
This is the most common type of endothelial keratoplasty and almost half of the UK’s corneal transplant patients suffer from this type of corneal damage. Patients with inherited eye problems like Fuchs' dystrophy are also eligible for this type of surgery.
Removal only
Fulch's dystrophy patients may alternatively receive a more simple procedure involving only the removal of the affected part of the eye without a transplant. If the surrounding cells are healthy, they naturally fill the removed area. This procedure is usually only performed if the damage affects the inner membrane of the cornea.
How long does corneal transplant surgery take?
Getting a corneal transplant has many moving parts, starting with diagnosis and recommendation for surgery and ending with the recovery process.
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How long does it take to book a corneal transplant?
When a doctor diagnoses you with corneal damage, you will be recommended for a corneal transplant. The waiting time is usually minimal in the UK and around 4,500 corneal transplants per year are executed. Factors such as availability of healthy tissue, medical staff and resources will all factor into waiting times.
Before progressing to surgery, you may be subject to requisite health checks for safety. You may also be asked to stop taking certain medicines or pain killers a couple of weeks before the procedure. At least one day before, antibiotic drops are usually administered to prevent infection.
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How long is corneal transplant surgery?
Most commonly, corneal transplants can be done as an outpatient procedure under local anaesthetic and will be able to go home the same day. For the procedure the patient is awake, but numbness will supress sensations of pain.
The surgery itself can last between 30 minutes to an hour. To allow for complications, doctors set an expectation for a maximum of two hours.
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How long is recovery from a corneal transplant?
The healing process post-corneal surgery can take a few weeks to a year before full vision improvements are noticeable. Healing time varies particularly by procedure, with full thickness transplant (PK) typically being the slowest to heal and endothelial keratoplasty (DSEK) being the fastest.
After surgery, you'll probably wear an eye patch for 1-4 days (at least a day) until the top layer of your cornea heals. Your eye will most likely be red and sensitive to light. It might hurt or feel sore for a few days, but some people don't feel any discomfort.
Your cornea doesn't get any blood, so it heals slowly. If you needed stitches, your doctor will take them out a few months later.
What can patients expect from vision after a corneal transplant?
Corneal transplants aim to restore significant or partial vision and relieve long-term eye discomfort. Recovery is different for every patient, though, and eyesight might appear worse before improvements are visible.
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What is the success rate of corneal transplant surgery?
Most corneal transplants are successful at restoring at least partial vision. On average, the results will last without complications for 10 years or more.
Some complications can occur as a result of surgery, however. Additional problems can include:
- Infections
- Eye bleeding
- High pressure in the eye (glaucoma)
- Clouding in the lens (cataracts)
- Corneal swelling
- Detached retina (back part of the eye falls away and restricts vision)
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Can corneal transplant rejection happen?
Transplants are not always successful as the body can reject the donated tissue. The immune system is hard-wired to attack threatening new matter in the body, so mistaking transplanted tissue as a threat will cause the transplant to fail. The chance of this occurring is approximately 1 in 10.
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What is corneal transplant aftercare?
There should be no intense pain after the surgery, so painkillers such as paracetamol should suffice. However certain measures need to be taken to ensure safe recovery.
Patients will be given an eye patch and a plastic shield to wear for at least one week before the first check-up with an ophthalmologist.
Longer-term, steroid eye drops (or other medications) might need to be used from one year to life-long, depending on the case. Finally, your glasses or contact lens prescription will likely require some adjustments to cater to changes in the shape of the cornea.
How much does a corneal transplant cost?
In the UK, corneal transplants are available to eligible UK citizens via the NHS. However, private healthcare providers can also deliver this surgery at cost.
An individual price quotation will be generated after an initial assessment with a private healthcare professional. This figure may depend on a number of factors, including the type of surgery you need, any complications, and any additional services at the discretion of the patient and the provider.
In other parts of the world where access to free healthcare is not available, patients would be expected to pay for their own treatment. The price will vary and be influenced by a number of factors including:
- Geography
- Availability
- Chosen service provider
As a ballpark figure, in the USA, those without health insurance can expect to pay between $15,000 and $24,000 USD for a corneal transplant. Private healthcare patients may be expected to pay an equivalent in the UK.
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