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Corneal Transplant

When traumatisms, infections or degenerative diseases affect the corneal transparency or destort it, corneal graft is the solution. Discover the different treatments we can offer you.

What is corneal graft?

A cornea transplant is an operation to replace part of the cornea with corneal tissue from a donor. This operation is sometimes called keratoplasty. It is most often used to restore vision to a person with a damaged cornea. A corneal graft can also relieve pain or other symptoms associated with cornea diseases.

What are the different types of grafts?

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

The other layers are preserved, which provides less trauma and a better visual recovery. There are a few types of endothelial keratoplasty. They are known as:

  • DSAEK — Descemet's Stripping (Automated) Endothelial Keratoplasty
  • DMEK — Descemet's Membrane Endothelial Keratoplasty

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 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 the recovery is quicker because the transplant tissue is thinner.

Your eye surgeon will choose the type of surgery based on your cornea’s condition. Doctor Donate performs endothelial transplants (DSAEK and DMEK) since 2007.

What are the conditions which can be treated with corneal graft?

We can treat many corneal pathologies with a corneal graft. The most common indications are related to a loss of transparency or deformation of the cornea. Here are some common eye problems that can lead to a damaged cornea:

  • Fuch’s dystrophy, when cells in the inner layer of the cornea are not working effectively
  • Keratoconus, when the cornea is cone-shaped rather than dome-shaped
  • Eye infections or injuries that scar the cornea
  • Previous corneal surgery or other eye surgery that damaged the cornea

What are the corneal graft risks?

Risks include:

  • Eye infection
  • Increased risk of clouding of the eye’s lens (cataract)
  • Pressure increase within the eyeball (glaucoma)
  • Rejection of the donor cornea
  • Swelling of the cornea

What are the advantages of endothelial transplants?

This technique allows changing only the layer of the cornea which is damaged, while preserving the other layers. No stitches are needed. It is less traumatic for the eye, visual recovery is faster, visual results are better and the transplant’s rejection risk is limited. It requires great skill and significant experience of the surgeon to ensure postoperative visual quality in the patient. We have performed this surgery in the Bellecour Vision Clinic since 2007. Our experience allows us to guarantee the effectiveness, safety as well as the lifespan of the graft.

What are the corneal graft alternatives?

The transfixing corneal transplant (or transfixing keratoplasty) is a surgical technique which consists in replacing a central corneal disc of full thickness comprising the epithelium, the stroma, the membrane of Descemet and the endothelium of part of the cornea thanks to a 360 degrees incision. A graft of the same diameter is then placed and sutured by separate stitches or by an overlock to the collar of the recipient’s cornea. These points are removed 2 years after the transplant.

Corneal graft results

Visual recovery takes about one month (compared to 1 year with a transfixing graft). Visual improvement is on average 6/10 and can reach 10/10.

After the operation, it is necessary to wear glasses to correct the induced astigmatism. Still, the correction is generally weak, unlike the required correction after a transfixing transplant which induces astigmatism of 4 to 5 diopters on average. The postoperative effects are generally painless. Sometimes people experience the feeling of a grain of sand present during the first hours. Headaches are possible.

After surgery, you will need to use eye drops for nine months. This is to prevent postoperative infection and reduce the risk of rejection.

During the week following the operation, you must:

  • Avoid dusty atmospheres
  • Do not rub your eye
  • Disinfect your hands often with a hydro alcoholic gel, especially when instilling eye drops

Your postoperative follow-up will consist of several check-ups:

  • The day after the operation
  • At 8 days
  • At one month
  • At three months
  • At one year
  • Then once a year after that