Corneal Transplant Surgery with Images | Accurate Medical Facts and Information

The cornea is the clear, dome-shaped tissue that forms the eye’s front protective layer. It is responsible for most of the eye’s focusing power, and any condition that reduces corneal transparency will lead to loss of vision. In this article from Batal Specialized Eye Center, we will explain everything related to corneal transplant surgery with images.

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Types of Corneal Transplant Surgery

Corneal transplant surgery involves selectively replacing the diseased or damaged part of the cornea with healthy donor tissue, such as the endothelium in Fuchs’ dystrophy, or the stroma in keratoconus.

In some cases, all layers of the cornea need to be replaced in what is called a full‑thickness (penetrating) keratoplasty (PK). You will undergo a comprehensive eye examination, including advanced corneal scanning or mapping using devices such as the Pentacam HR or the Zeiss Atlas system. Based on these results, you will be able to make an informed decision about which procedure is best suited for you.

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Descemet Stripping Endothelial Keratoplasty (DSEK)

Descemet Stripping Endothelial Keratoplasty (DSEK) is a procedure specifically designed to replace lost or dysfunctional corneal endothelial cells, whether due to a hereditary condition such as Fuchs’ endothelial dystrophy, or as a result of trauma from previous surgery such as pseudophakic bullous keratopathy.

During DSEK, the damaged inner layer of endothelial cells, along with its supporting tissue (Descemet’s membrane), is removed from the eye through a small entry port just a few millimeters wide.

A new layer of endothelial cells with its supporting membrane is then prepared from a donor cornea as a small disc, typically 8–9 mm in diameter and about one‑tenth of a millimeter thick.

This disc is gently folded and inserted into the eye through the same small incision using a special injector. It is then carefully unfolded and positioned against the underside of the cornea.

An air bubble is used to press the graft into place, and the endothelial cells immediately begin pumping fluid out of the swollen cornea, which helps the new layer adhere to the cornea.

A smaller air bubble is left in the eye to support the new tissue sheet while it continues to adhere and strengthen in place. This bubble gradually absorbs on its own over the next few days.

Instead of the 16 sutures typically needed to hold a PK graft in place, DSEK usually requires only a single stitch, which is often removed at the second follow‑up visit, about a month later.

DSEK offers significant advantages over PK in conditions causing endothelial failure: the eye is more structurally stable, visual recovery is faster, the risk of trauma‑related complications is lower, and changes in glasses prescription are generally much less, which speeds up the return of functional vision.

For these and other reasons, selective endothelial keratoplasty has become the “gold standard” treatment for many causes of endothelial failure. Only one stitch is usually required and, again, it is commonly removed at the second follow‑up around one month after surgery.

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Corneal Transplant Surgery with Images: What to Expect

This surgery is usually performed under local anesthesia, although general anesthesia can also be used. On the day of your procedure, you will be admitted to a dedicated room with attached facilities. Once anesthesia is given, the operation typically takes about 40 minutes.

When you return to your room, you will be asked to lie relatively flat and look up at the ceiling for a few hours so that the air bubble can float upward and keep pressing the new cell layer into place.

You may sit or stand briefly—for example, to have your meals—but then you will be asked to lie down again.

Your vision will be blurry due to the air bubble, but this will gradually be absorbed over the coming days. Most patients prefer to stay overnight and go home the next day, although staying in the hospital is not strictly required.

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Post‑operative Care After Corneal Transplantation

You may feel some grittiness or discomfort in the operated eye immediately after surgery, but it should not be severely painful. A clear protective shield will be placed over the eye at the end of the procedure to keep it safe.

You will need to use eye drops frequently in the early post‑operative period, then gradually taper the frequency over the following months. You typically will not need oral anti‑rejection medication unless there are special circumstances.

On the first or second day, you will be asked to lie as flat as possible while the air bubble is still present. Your vision will be blurred, although most people are not consciously aware of seeing the bubble itself. You must arrange transportation home from the hospital, as you will not be allowed to drive.

You should avoid heavy lifting or strenuous activity for the first few weeks after surgery and take care to protect the eye—for example, by wearing eye protection when gardening or playing sports such as badminton or squash. As the new endothelial layer continues to clear the cornea, your vision will gradually improve.

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Penetrating Keratoplasty (PK)

Penetrating keratoplasty (PK) was first performed in 1905 and is therefore a very well‑established procedure. In PK, the full thickness of the damaged cornea is replaced with a healthy donor cornea, usually about 8 mm in diameter.

The new cornea is secured in place with very fine sutures, each about a quarter of the thickness of a human hair. The stitches are buried within the cornea so they cannot be felt.

Because the cornea has no blood vessels, healing between the donor and recipient cornea is slow and may take many months to years. It is therefore crucial to avoid any trauma to the new cornea.

The operation is usually done under general anesthesia and typically takes about one hour. After surgery, you may feel a slight scratchy sensation in the eye, but it should otherwise be comfortable. You will not usually need to stay overnight in the hospital, but you must attend a follow‑up visit within the first week after surgery.

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You will be asked to use eye drops frequently over the first few days, then gradually reduce their use over several months. You can usually resume normal daily activities, but you must be careful to protect the eye from injury.

We will ask you to wear protective glasses at night. Your vision will be blurry immediately after surgery, and it will improve gradually over the following weeks to months. You must arrange transportation home from the hospital since you will not be able to drive.

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Deep Anterior Lamellar Keratoplasty (DALK)

Deep Anterior Lamellar Keratoplasty (DALK) is a variation of PK in which the epithelium and stroma are replaced, but the patient’s own endothelium is preserved, instead of replacing all corneal layers with a full‑thickness donor disc.

DALK is particularly useful for treating conditions that affect only the front layers of the cornea and are too deep to be treated with laser surface reshaping. DALK can be performed using two main techniques depending on the case: conventional DALK and big‑bubble DALK (bb‑DALK).

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When to See a SpecialistWhen to See a SpecialistWhen to See a Specialist

Whatever your vision problems, refractive errors, or corneal diseases may be, these are delicate medical conditions that require thorough evaluation and proper treatment by a skilled and experienced ophthalmologist, using effective medical technologies that can deliver real, positive results.

Whatever condition is affecting your eyes, you can book an appointment at Batal Specialized Eye Center for a full examination and to begin appropriate treatment, no matter how complex your eye problem may be.