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Corneal Transplantation

Corneal transplantation, also known as corneal grafting or penetrating keratoplasty, is a surgical Corneal transplantationprocedure where a damaged or diseased cornea is replaced by donated corneal tissue. The cornea is the clear part of eye in front of the iris and pupil. An unhealthy cornea affects your vision by scattering or distorting light and causing blurry or glary vision. A cornea transplant may be necessary to restore your functional vision. The surgical procedure is performed by ophthalmologists, medical doctors who specialize in eyes and are often done on an outpatient basis.

A cornea transplant may be suggested due to any of the following reasons:

  • Scarring from infections, such as eye herpes or fungal keratitis
  • Eye diseases such as keratoconus
  • Hereditary factors or corneal failure from previous surgeries
  • Thinning of the cornea and irregular shape (such as with keratoconus)
  • Complications from LASIK
  • Chemical burns on the cornea or damage from an eye injury
  • Excessive swelling (edema) on the cornea

On the day of the surgery, the patient is given a brief physical examination by the surgical team and is taken to the operating room in the hospital or an outpatient surgery center. A local or general anesthesia may be used, depending on the health, age of the patient and whether or not you prefer to be asleep during the procedure. With local anesthesia, an injection into the skin around your eye is used to relax muscles that control blinking and movement and eye drops are used to numb the eye itself.

An eyelid speculum is used to keep the lids open, along with suitable lubrication to prevent the eye from drying. A metal ring is then stitched to the sclera, which will provide a base for a trephine. The surgeon inspects and measures the affected corneal area in order to determine the size of the transplantation. A trephine is then placed over the cornea and is used by the surgeon to cut the host cornea. The trephine is then removed and the surgeon cuts a circular graft from the donor cornea. A tissue nearly identical in shape is then sutured into place. Once this is done, the surgeon returns to the patient's eye and removes the host cornea.

The donor cornea is then brought into the surgical field and maneuvered into place with forceps. Once in place, the surgeon will fasten the cornea to the eye with a running stitch (as used in the upper image above) or a multiple interrupted stiches (as in the lower image). The surgeon finishes up by reforming the anterior chamber with a sterile solution injected by a cannula, then testing that it's watertight by placing a dye on the wound exterior.

With the metal ring removed and antibiotic eye drops placed, the eye is patched and the patient is taken to a recovery area while the effects of the anesthesia wear off. The patient typically goes home following this and sees the doctor the following day for the first post operative appointment.

A plastic shield will be put over your eye to protect it from being inadvertently rubbed or bumped. The procedure takes approximately two hours.


While the cornea is avascular, there is still a potential for some blood loss, usually from suturing the metal ring to the sclera. Any blood loss is typically less than 2ml.

There are also risks of infection. The cornea takes all its nutrients from the aqueous humor and hence has no blood vessels. This makes the healing much slower than a cut on the skin. Infection is a risk during this healing period due to various microorganisms. This risk is minimized by using antibiotic eye drops, even when no infection exists.

Graft failure can occur at any time after the cornea has been transplanted, even years or decades later. The causes can vary, though it is usually due to new injury or illness. Treatment can be either medical or surgical, depending on the individual case. An early, technical cause of failure, may be an overly tight stitch cheese wiring through the sclera.


Total recovery period of a corneal transplant can last upto a year or longer. At first you will have blurry vision and the site of the corneal transplant may have some swelling which shows as slightly thicker than the rest of the cornea. As vision is restored to normal, you will be able to slowly return to your normal activities..

In the initial weeks after surgery, you will be not allowed to do any heavy exercise or lifting. You should be able to return to work in about a week after the surgery. There will be steroid eye drops prescribed in order to help you body accept the new corneal graft. Care should be taken by protecting your eye with a pair of eyeglasses to avoid anything entering or bumping into your eye.

Depending on the rate of healing and the health of your eye, stitches will be removed in 3-17 months after the surgery. In order to reduce the amount of astigmatism, caused by an irregular eye surface, adjustments may be made to the sutures surrounding the new cornea.


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