Corneal transplant (Keratoplasty)

Your consultant may recommend a corneal transplant if your cornea becomes damaged due to injury or disease. Corneal transplant surgery aims to restore vision, reduce pain and improve the appearance of a damaged cornea.

A corneal transplant may be used to treat:

• Keratoconus - a condition where the cornea thins and becomes cone-shaped
• Thinning, swelling, clouding, or tearing of the cornea
• Corneal scarring due to disease, infection, or injury
• Corneal ulcers (keratitis) that haven't responded to other treatments
• Fuchs dystrophy - a genetic condition where fluid builds up in the cornea causing swelling and thickening
• Endothelial decompensation - a condition where the cornea becomes swollen and cloudy
• Complications of previous eye surgery

At your first consultation, you will usually be seen by a consultant ophthalmologist, a doctor specialising in conditions affecting the eye.

Your consultant will ask you about your symptoms, medical history and general health. They will perform a thorough eye examination to check for any other eye conditions and take the measurements of your eye to determine the size of the donor cornea you need. If you have any other eye problems, these will be treated before your corneal transplant to reduce the risk of complications after your surgery.

At the end of your appointment, your consultant will decide whether a corneal transplant is right for you based on your symptoms, diagnosis, and general health. They will explain what happens during the surgery as well as any possible risks and complications and what to expect during your recovery. It is important to us that you are as well-informed and comfortable as possible before, during and after your surgery, so please ask your consultant any questions you may have.

Your consultant will tell you everything you need to do to prepare for your corneal transplant. If there's anything you're not sure about, or if you have any questions about how to prepare for your surgery, speak to your consultant or call the hospital for advice. Being well-prepared for your surgery will help to ease any anxiety you may have as well as allow your surgery and recovery to go more smoothly.

Before your surgery, tell your consultant about any medical conditions or allergies you have, and any medication you are taking, including over-the-counter medicines. You might need to stop taking certain medications before your operation, in particular blood thinners. This is to reduce the risk of bleeding during and after your surgery.

You may not be able to eat or drink anything from midnight on the day of your operation. Check with your consultant when you need to stop eating and drinking before your surgery.

What lifestyle changes can I make before my surgery?

Being in optimal health before your surgery can reduce the risk of complications and speed up your recovery.

To make sure you are as healthy as possible before your surgery:

• Eat a healthy, balanced diet with plenty of fruit, vegetables, lean proteins and whole grains
• If you smoke, try to stop at least eight weeks before your surgery
• Avoid alcohol for a few days before and after your surgery. Alcohol thins the blood and can increase the risk of bleeding
• Take regular exercise

Your corneal transplant may be done under general anaesthetic, which means you'll be asleep for the procedure, or local anaesthetic, where you'll be awake but won't feel any pain. The operation takes between one and two hours.

There are several different types of corneal transplant surgery. Some replace the entire cornea while others only remove the damaged part and replace it with healthy tissue. Which one is right for you depends on how much of your cornea is damaged and which part of your cornea needs replacing.

Penetrating keratoplasty (PK)

This is a full-thickness transplant to replace your entire cornea. During the procedure, your consultant uses a specially designed circular blade to remove your cornea and replace it with one from a donor. The new cornea is then stitched into place.

Deep anterior lamellar keratoplasty (DALK)

This is a partial thickness transplant where the outer and middle layers of the cornea are replaced with donor tissue and stitched into place.

Endothelial keratoplasty (EK)

There are two types of endothelial keratoplasty:

• Descemet stripping automated endothelial keratoplasty (DSAEK)
• Descemet membrane endothelial keratoplasty (DMEK)

During both types of endothelial keratoplasty surgery, diseased tissue is removed from the innermost layer of the cornea and replaced with donor tissue. DSAEK uses a thicker layer of donor tissue while DMEK uses a thinner one. This type of surgery does not use stitches and the transplanted cornea is held in place with an air bubble.

Recovery from any type of surgery is different for everyone and depends on factors such as your age, general health and whether or not there were any complications during your surgery or recovery. This guide offers a general estimate, but your consultant will be able to give you a more tailored corneal transplant recovery timeline estimate based on your individual circumstances.

After your surgery, you will be taken to the recovery room where you will be monitored closely until the effects of the anaesthetic have worn off. You will then be taken to your room.

For some types of corneal transplant surgery, you may need to lie flat as much as possible for the first twenty-four hours after your transplant. You can sit up and walk around when you need to eat meals and use the bathroom.

You may experience redness, soreness, and sensitivity to light for a few days after your corneal transplant. You will be given eye drops to help reduce inflammation and prevent infection. You may also be given medication to help with any post-operative pain.

You will need to take precautions to protect your eye after your surgery and may be advised to wear eye shields or sunglasses to avoid injury or damage to your eye. Avoid smoky or dusty places and do not press or rub your eye after your surgery.

You may be given an eye patch to wear at night and in the shower for the first few weeks after your transplant surgery. After your corneal transplant, you can bathe and shower as normal, but take care not to get water in your eye.

Avoid heavy lifting, swimming, or vigorous exercise until your consultant tells you it is safe to do so.

You will be given regular follow-up appointments to make sure your eye is healing well and to check for any signs of rejection.

How many nights will I need to stay in hospital?

After your surgery, you may be able to go home later the same day, or you may need to spend one night in hospital.

Will I be able to drive home?

You will not be able to drive yourself home from hospital after your corneal transplant. Please make arrangements for someone to come and collect you, or we can organise a taxi if you prefer.

How soon can I go back to work?

If your job is sedentary, you can expect to return to work around two to three weeks after your surgery. If you have a physically demanding job, it may be three to four months before you can return to work.

How soon can I drive?

Do not drive until your consultant gives you the all-clear to do so. You should also check with your insurance company as they may have additional regulations about when you're safe to be back on the road.

When will I be back to normal?

Most people can resume most normal daily activities within two to three weeks of corneal transplant surgery, but your vision may be blurred for several months to a year and often gets worse before it gets better. When your cornea has fully healed, your consultant can recommend some adjustments to improve your vision. This may include further surgery to alter the shape of your cornea, prescription glasses or contact lenses or laser eye surgery.

As with all types of surgery, corneal transplant surgery carries a small risk of complications. Your consultant will explain all the possible risks and complications before your surgery and answer any questions you may have about your procedure. Being as well-informed as possible about what to expect from your surgery will help put your mind at rest and allow you to make an informed decision, so please ask any questions you may have.

Possible complications of any surgery include:

• Bleeding
• Infection
• Blood clots
• Adverse reactions to the anaesthetic

Possible complications specific to corneal transplant include:

• Glaucoma (increased pressure in the eye)
• Clouding of the lens (cataracts)
• Swelling of the cornea
• Detached retina
• Detachment of the new cornea
• Corneal rejection

Corneal transplant rejection

Corneal transplant surgery uses donor tissue from a cadaver (deceased person). After your corneal transplant, there is a chance that your body`s immune system could attack the foreign tissue. This is called rejection and occurs in around three out of ten patients who have undergone a full-thickness corneal transplant (penetrating keratoplasty). The risk is lower with partial thickness corneal transplants.

Your consultant will give you instructions on how to minimise your risk of corneal rejection. Follow your consultant's instructions carefully and call the hospital if you have any questions or concerns.

Contact your healthcare provider immediately if you experience:

• Eye pain
• Extreme sensitivity to light
• Cloudy or hazy vision
• Eye redness

We answer some of your most commonly asked questions about corneal transplant surgery.

How long do the stitches stay in after a corneal transplant?

As the cornea has no blood supply, it heals slowly. If you had stitches during your surgery, they are normally removed after about a year.

How many times can you have a corneal transplant?

Corneal transplants can be repeated as many times as necessary as long as there is a reasonable chance of success and your eye can tolerate further operations. If your transplant fails or doesn't restore your vision, it is possible to have further corneal transplants.

Can a corneal transplant cure keratoconus?

While a corneal transplant does not cure keratoconus, in most cases it can stop the condition from getting worse.

Can a corneal transplant restore vision?

Yes, in many cases a corneal transplant can improve or even restore vision though it may take several months to a year to see a result. You may also need to continue wearing glasses or contact lenses to correct your vision after your corneal transplant.

Can you fly after a corneal transplant?

If you have had an air bubble injected to hold your corneal transplant in place, you will need to wait until it has been reabsorbed before travelling by plane. Check with your consultant when it is safe for you to fly after your corneal transplant.

Do corneal transplants last forever?

You can expect your corneal transplant to last at least ten years without complications and in some cases, they last forever. You can help your corneal transplant last by following your consultant's instructions carefully, avoiding damage or injury to your eye and having regular follow-up appointments.

Do you need to take immunosuppressants after a corneal transplant?

After your corneal transplant, you will need to use steroid eyedrops to help prevent your body from rejecting the donor tissue. These may continue long-term or be stopped after around a year. If you are at high risk of rejecting your implant, your consultant may also prescribe oral immunosuppressants.

At Circle Health Group, we have the experience and expertise to ensure the best possible care and outcome for our patients. As a patient with Circle Health Group, you can expect the highest standards of care including:

• Flexible appointment times and locations that are convenient for you
• The freedom to choose which hospital and consultant suit your needs
• Personalised, consultant-led treatment plans tailored to your individual needs
• Comfortable and safe private facilities maintained by expert multidisciplinary teams
• Private ensuite rooms as standard
• A range of delicious healthy meals
• Affordable, fixed-price packages with aftercare included
• Flexible payment options to help you spread the cost of your care

If you would like to see a consultant or learn more about corneal transplants, book your appointment online today or call a member of our team directly on 0141 300 5009.

Content reviewed by Circle in-house team in March 2023. Next review due March 2026.

1. Overview: Cornea transplant, NHS
2. Corneal transplant, RNIB
3. About corneal transplantation, American Academy of Opthalmology
4. Corneal transplantation, John Hopkins