Corneal Transplantation

Corneal transplantation is a surgical procedure in which corneal tissue that has lost its transparency or has been damaged is replaced with a healthy donor cornea.

Corneal transplantation is the process of replacing damaged corneal tissue with a healthy donor cornea. This surgical method is applied when the cornea, the outermost layer of the eye that enables clear vision by refracting light, loses its function for various reasons. Today, thanks to advanced surgical techniques, corneal transplantation can be performed as full-thickness or partial.

What is Corneal Transplantation?

Corneal transplantation (keratoplasty) is an eye surgery performed to replace all or certain layers of the cornea in cases of corneal problems that reduce vision.

Because the cornea is exposed to external influences, it can lose its transparency, become deformed, or its tissue can be permanently damaged due to infection, trauma, or structural defects. In these cases, the cornea's ability to refract light properly and transmit images clearly decreases. Corneal transplantation restores corneal functions.

Corneal transplantation can be performed in different ways depending on which layers of the cornea are damaged:

Full-thickness corneal transplantation: This approach replaces the entire thickness of the cornea.
Partial (layered) corneal transplantation: These are approaches where only the damaged layers of the cornea are replaced.

The method to be applied is determined after a detailed examination by the doctor, depending on the location and depth of the damage to the cornea. Thanks to advanced techniques today, corneal transplantation is a treatment method that can be applied safely.

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In Which Cases is Corneal Transplantation Performed?

Corneal transplantation is performed when the corneal tissue has lost its transparency, its shape has been distorted, or it has been permanently damaged. Corneal transplantation is generally performed in the following cases:

Permanent cloudiness and loss of transparency in the cornea

When the cornea loses its transparency, light cannot enter the eye properly, and the image becomes blurred. This can be caused by previous corneal infections, trauma (permanent damage after scratches, blows, chemical contact), or corneal lesions left by previous eye diseases or injuries. If such transparency loss significantly reduces vision and cannot be corrected by other methods, a corneal transplant may be considered.

Keratoconus

Keratoconus is a condition in which the cornea thins and protrudes forward over time, leading to impaired vision. Although it can be controlled with glasses, lenses, and various treatments in the early stages, a corneal transplant may be considered if vision cannot be adequately corrected with glasses/lenses, if advanced thinning and irregularity of the cornea develops, or if permanent damage occurs on the corneal surface.

Permanent damage after corneal infections

Some corneal infections can leave permanent scarring, cloudiness, or tissue loss in the cornea even after healing. This prevents light from entering the eye properly and can significantly reduce vision. Corneal transplantation may be considered when permanent scarring, thinning of the cornea, or non-healing ulcers occur after an infection.

Permanent edema in the cornea

The endothelial layer on the inner surface of the cornea is responsible for maintaining the fluid balance that keeps the cornea transparent. When this layer does not function properly, the cornea collects fluid, swells, and vision becomes cloudy. This can occur due to certain age-related endothelial diseases, endothelial damage after previous eye surgeries, or persistent edema developing after long-term corneal problems. If the visual impairment significantly affects daily life and is permanent, a transplant may be planned.

Failure of a previous corneal transplant

In some patients who have undergone a previous corneal transplant, the transparency of the transplanted tissue may deteriorate or its function may decrease over time. If vision significantly decreases again and there are no other options, a second corneal transplant may be considered.

Hereditary corneal dystrophies (genetic corneal diseases)

In some rare cases, the cornea may have lost its transparency from birth or may develop severe damage during childhood. In cases that seriously affect vision and are permanent, a transplant may be planned.

Chemical Burns of the Corneal

Acids, alkalis (such as bleach), or other chemical substances can seriously damage corneal tissue. Loss of corneal transparency, vascularization, and permanent vision loss may develop after a burn. If the cornea does not recover despite appropriate treatments, a corneal transplant may be performed.

How is a Corneal Transplant Performed?

Corneal transplant surgery is usually performed under local anesthesia; the patient is not completely put to sleep, only the eye and surrounding area are numbed to make the procedure comfortable. However, general anesthesia may be preferred in pediatric patients, individuals who have difficulty remaining still, or in cases where it is deemed necessary.

During the surgery, the damaged corneal tissue is carefully removed, and a donor cornea prepared to the appropriate dimensions is placed in its place. The procedure is completed using microsurgical techniques, and at the end of the surgery, the eye is covered with a protective dressing.

Today, there are two most commonly used methods in corneal transplantation: DALK and DMEK procedures. Which method will be applied is determined according to which layer of the cornea is damaged.

DALK (Anterior Corneal Transplantation)

In this method, damaged tissues in the front part of the cornea are removed, but the innermost layer, the endothelium, is preserved. That is, the patient's healthy inner corneal layer is left in place. Then, a healthy anterior layer taken from a donor is placed in the prepared area and secured with fine sutures. This method is particularly preferred in patients whose inner corneal layer is intact.

DMEK (Corneal Endothelial Layer Transplantation)

In this method, the problem is in the innermost layer of the cornea. In this case, only the damaged endothelial layer is removed. A very thin inner layer taken from the donor cornea is placed inside the eye and attached to the back surface of the cornea using special techniques. Usually, a small air bubble given to the eye helps the new tissue to adhere to its place.

What is the Recovery Process Like After a Corneal Transplant?

The recovery process after a corneal transplant requires patience. Even if the surgery is successful, vision does not immediately become clear. The cornea is the most sensitive and transparent layer of the eye. It takes time for the newly transplanted tissue to adapt to the eye, for the swelling to subside, and for vision to stabilize. This process may vary from person to person, but regular follow-up is very important.

The following are considered normal in the first few days after surgery:

Blurred vision
Mild pain or stinging sensation
Redness in the eye
Sensitivity to light
Tearing

These symptoms usually decrease over time. The most important thing in the first few days is to use the drops prescribed by the doctor regularly and to protect the eye from impacts.

Generally within the first 1-3 months:

Redness decreases.
Discomfort lessens.
Vision gradually begins to clear.

However, vision may not be fully restored during this period. Full vision restoration after a cornea transplant usually takes between 6 months and 1 year. This period may be shorter in some patients and longer in others.

If there are stitches, they can be removed or adjusted over time as deemed necessary by the doctor. For a healthy recovery, it is very important to use the drops on time and regularly, not to rub the eye, to protect it from blows, not to miss check-ups, and not to stop taking medication without the doctor's recommendation.

Frequently Asked Questions About Cornea Transplantation

Is Cornea Transplantation a Difficult Surgery?

It is a delicate surgery requiring microsurgery, but it is performed safely by experienced surgeons.

How Many Days Does Cornea Transplantation Take to Heal?

Initial healing begins within a few weeks, while full vision restoration may take several months depending on the method used.

How Many Stitches Are Used in a Cornea Transplant?

Full-thickness transplants usually require around 16 fine sutures; some methods may use fewer or no sutures at all (such as DMEK).

Is Corneal Transplantation Performed in Türkiye?

Yes, it is successfully performed in many well-equipped eye centers in Turkey.

Is the Patient Sedated During Corneal Transplantation?

It is mostly performed with local anesthesia, but general anesthesia may be preferred in some cases.

What Happens If Corneal Transplantation Is Not Performed?

In severe corneal damage, vision loss may progress, and in some cases, the structural integrity of the eye may be at risk.

How Long Does a Corneal Transplant Last?

The transplanted cornea can function for many years; the duration depends on the patient's eye structure and compliance with follow-up appointments.

Who is a Candidate for Corneal Transplantation?

It is performed on patients whose vision is significantly reduced due to permanent corneal damage, cloudiness, deformity, or endothelial insufficiency.

What is the Vision Rate After Corneal Transplantation?

The vision rate after corneal transplantation varies depending on the patient's current eye condition, but most patients achieve a significant increase in vision; however, the exact result is individual. Vision restoration after a corneal transplant can take between 6 months and 1 year.