Your Comprehensive Guide to Modern Corneal Transplant Surgery

The cornea is the clear, dome-shaped outer layer of the eye that provides most of its focusing power. When this tissue becomes scarred, cloudy, or damaged due to disease like Keratoconus, trauma, or hereditary conditions like Fuchs’ Dystrophy, a Corneal Transplant (keratoplasty) may be necessary to restore clear vision.

Modern ophthalmology has revolutionized corneal surgery. It’s no longer a one-size-fits-all procedure. Today, surgeons often replace only the diseased layers of the cornea, leading to faster recovery and lower complication rates.

At Mechi Netralaya’s Cornea Clinic, we specialize in the full range of corneal transplant techniques. Here is a guide to the different types:

1. Penetrating Keratoplasty (PKP)

• What it is: PKP is the traditional, full-thickness corneal transplant. It involves removing all five layers of the patient’s damaged cornea and replacing it with a full-thickness donor cornea.

• When it’s used: It is used when all layers of the cornea are damaged or scarred, typically due to severe trauma or advanced, full-thickness scarring.

• Pros & Cons: It offers a complete replacement but requires longer recovery time (up to 12 months or more) and has a higher risk of graft rejection compared to newer techniques.

2. Deep Anterior Lamellar Keratoplasty (DALK)

• What it is: DALK is a partial-thickness transplant that replaces the diseased front layers (epithelium, Bowman’s layer, and stroma) while leaving the patient’s healthy innermost layer (endothelium) intact.

• When it’s used: This is the preferred method for diseases that primarily affect the front of the cornea, such as advanced Keratoconus or some superficial scars.

• Pros & Cons: By preserving the patient’s own endothelium, DALK significantly reduces the risk of long-term graft rejection and promotes faster recovery compared to PKP.

3. Descemet’s Membrane Endothelial Keratoplasty (DMEK)

• What it is: DMEK is the most advanced and delicate partial transplant. It involves replacing only the endothelium (the innermost layer) and Descemet’s membrane, leaving the patient’s other layers untouched. The donor tissue is incredibly thin—thinner than a human hair.

• When it’s used: DMEK is the gold standard for conditions that cause the cornea to swell from the back, such as Fuchs’ Endothelial Dystrophy.

• Pros & Cons: DMEK offers the fastest visual recovery (often within weeks) and the lowest risk of rejection, making it an excellent option for patients whose damage is confined to the inner layer.

The Role of the Cornea Clinic

The decision of which transplant procedure is right for you depends entirely on which layers of your cornea are affected. Our specialized Cornea Clinic uses advanced diagnostic equipment to determine the exact depth and extent of the damage, ensuring we select the procedure that offers you the best and quickest path to clear vision.