During the procedure
On the day of your cornea transplant, you'll be given a sedative to help you relax and a local anesthetic to numb your eye. You won't be asleep during the surgery, but you shouldn't feel any pain.
During the most common type of cornea transplant (penetrating keratoplasty), your surgeon cuts through the entire thickness of the abnormal or diseased cornea to remove a small button-sized disk of corneal tissue. An instrument that acts like a cookie cutter (trephine) is used to make this precise circular cut.
The donor cornea, cut to fit, is placed in the opening. Your surgeon then uses a fine thread to stitch the new cornea into place. The stitches may be removed at a later visit when you see your eye doctor.
In some cases, if people aren't eligible for a cornea transplant from a donor cornea, doctors may insert an artificial cornea (keratoprosthesis).
Procedures to transplant a portion of the cornea
With some types of cornea problems, a full-thickness cornea transplant isn't always the most appropriate treatment. Other types of transplants may be used that remove only certain layers of cornea tissue, or only tissue affected by disease. These types of procedures include:
Endothelial keratoplasty (EK). This procedure removes diseased tissue from the back corneal layers, including the endothelium, along with the Descemet membrane, a thin layer of tissue that protects the endothelium from injury and infection. Donor tissue is carefully implanted to replace the removed tissue.
There are two types of endothelial keratoplasty. The most common type, called Descemet stripping endothelial keratoplasty (DSEK), uses donor tissue to replace about one-third of the cornea. A newer type of procedure, called Descemet membrane endothelial keratoplasty (DMEK), uses a much thinner layer of donor tissue. Because the tissue used in DMEK is extremely thin and fragile, this procedure is more challenging than DSEK, and not as commonly used.
Anterior lamellar keratoplasty (ALK). This procedure removes diseased tissue from the front corneal layers, including the epithelium and the stroma, but leaves the back endothelial layer in place.
The depth of cornea damage determines the type of ALK procedure that's right for you. Superficial anterior lamellar keratoplasty (SALK) replaces only the front layers of your cornea, leaving the healthy endothelium intact. A deep anterior lamellar transplant (DALK) procedure is used when cornea damage extends deeper into the stroma.
In DALK, a small incision is made in the side of your eyeball to allow for removal of your cornea's front and middle layers without damaging the back layers. Healthy tissue from a donor is then attached (grafted) to replace the removed portion.
After the procedure
Once your cornea transplant is completed, you can expect to:
- Receive several medications. Eyedrops and, sometimes, oral medications immediately after cornea transplant and during recovery will help control infection, swelling and pain.
- Wear an eye patch. An eye patch may protect your eye as it heals after your surgery.
- Protect your eye from injury. Plan to take it easy after your cornea transplant, and slowly work your way up to your normal activities, including exercise. For the rest of your life, you'll need to take extra precautions to avoid harming your eye.
- Return for frequent follow-up exams. Expect frequent eye exams in which your doctor looks for complications in the first year after surgery.