Corneal Transplantation: Partial and Full Thickness

When the cornea becomes cloudy, scarred, swollen or severely misshapen, a corneal transplant (keratoplasty) can replace the damaged tissue with healthy donor tissue. Today, many transplants replace only the diseased layer of the cornea rather than its full thickness.

Your surgeon will recommend the type of transplant based on which layer is affected.

Who it's for

• Advanced keratoconus or corneal scarring that cannot be managed with lenses or rings.
• Corneal swelling from inner-layer (endothelial) failure, such as Fuchs' dystrophy or swelling after previous eye surgery.
• Scarring after infection or injury.
• A previous transplant that has failed.

Types of transplant

• DALK (deep anterior lamellar keratoplasty): replaces the front layers of the cornea and keeps your own inner layer (endothelium). Because no donor endothelium is transplanted, endothelial rejection does not occur, but other types of graft rejection are still possible. Often used for keratoconus and scars that do not involve the inner layer.
• DMEK (Descemet membrane endothelial keratoplasty): transplants only the donor endothelium with its very thin supporting membrane (Descemet's membrane).
• DSAEK (Descemet stripping automated endothelial keratoplasty): transplants the endothelium and Descemet's membrane together with a thin layer of the back part of the corneal stroma, so the graft is thicker than in DMEK. DMEK and DSAEK are used for corneal swelling caused by endothelial failure and are done through a small incision.
• PKP (penetrating keratoplasty): replaces the full thickness of the central cornea.

How it works

1. Assessment: examination and scans to identify the affected layer and plan the operation.
2. Surgery: performed under local or general anaesthesia, depending on the case. In DMEK or DSAEK, an air or gas bubble holds the new layer in place.
3. Follow-up: frequent visits in the early weeks, then regular long-term check-ups.

Recovery

• After DMEK or DSAEK, you may be asked to lie face-up for a period so the bubble supports the graft. Vision often improves over weeks.
• While there is an air or gas bubble in the eye, do not travel by air or go to high altitude until your surgeon allows it, because the bubble can expand and raise the eye pressure dangerously.
• After DALK or PKP, the cornea has stitches, and vision improves slowly over many months. Stitches are adjusted or removed gradually, and glasses or contact lenses are usually needed.
• Steroid drops are used as instructed by your surgeon, often for a long time, to reduce the risk of rejection.
• Rejection can happen even years later. If you notice redness, light sensitivity, reduced vision or pain, seek assessment the same day: call the clinic, and if you cannot reach us promptly, go to the nearest emergency department.

Frequently asked questions

Your care team

• Surgery: Dr. Omar Khaled Al-Duwailah
• Assessment and follow-up: Dr. Omar Khaled Al-Duwailah, with our specialist medical team

This page provides general information and does not replace a medical consultation. Suitability, risks and results differ from person to person and will be discussed with you by your doctor.