• Corneal Transplant Surgery Options

    Written by: Kierstan Boyd
    Reviewed by: Elizabeth Yeu MD
    Sep. 01, 2016

    Full thickness corneal transplant

    Your entire cornea may need to be replaced if both the front and inner corneal layers are damaged. This is called penetrating keratoplasty (PK), or full thickness cornea transplant. Your diseased or damaged cornea is removed. Then the clear donor cornea is sewn into place.

    PK has a longer recovery period than other types of cornea transplants. Getting complete vision back after PK may take up to 1 year or longer.

    With a PK, there is a slightly higher risk than with other types of corneal transplants that the cornea will be rejected. This is when the body’s immune system attacks the new cornea tissue.

    Partial thickness corneal transplant

    Sometimes the front and middle layers of the cornea are damaged. In this case, only those layers are removed. The endothelial layer, or the thin back layer, is kept in place. This transplant is called deep anterior lamellar keratoplasty (DALK) or partial thickness corneal transplant. DALK is commonly used to treat keratoconus or bulging of the cornea.

    Healing time after DALK is shorter than after a full cornea transplant. There is also less risk of having the new cornea rejected.

    Endothelial keratoplasty

    In some eye conditions, the innermost layer of the cornea called the “endothelium” is damaged. This causes the cornea to swell, affecting your vision. Endothelial keratoplasty is a surgery to replace this layer of the cornea with healthy donor tissue. It is known as a partial transplant since only this inner layer of tissue is replaced.

    There are a few types of endothelial keratoplasty. They are known as:

    • DSEK (or DSAEK)
    • DMEK

    Each type removes damaged cells from an inner layer of the cornea called Descemet’s membrane. The damaged corneal layer is removed through a small incision. Then the new tissue is put in place. Just a few stitches—if any—are needed to close the incision. Much of the cornea is left untouched. This lowers the risk of having the new cornea cells being rejected after surgery.

    Some things to know:

    • With DSEK/DSAEK surgery, the donor tissue may be easier to transplant and position because it is thicker than the donor tissue in DMEK surgery.
    • In DMEK surgery, the donor tissue is thin and can be more difficult to transplant. But recovery is quicker because the transplant tissue is thinner.
    • Your eye surgeon will choose the type of surgery based on your cornea’s condition.