Definition

The cornea is a transparent, dome-shaped structure at the front of the eye. It permits light to enter the eye and directs light rays to the retina at the back of the eye.

A corneal transplant is a surgical procedure that involves replacing a damaged or diseased cornea with healthy donor tissue.

Alternative names

Keratoplasty; Penetrating keratoplasty; Lamellar keratoplasty; Keratoconus - corneal transplant; Fuchs' dystrophy - corneal transplant

Description

If the cornea loses its shape or clarity, then light cannot enter the eye correctly. Patients with corneal scarring, swelling or damage may experience blurry vision, decreased vision and issues with glare. In cases where the underlying cause cannot be resolved medically, an ophthalmologist (eye surgeon) may recommend cornea transplant surgery to replace diseased layers of the cornea with healthy layers from a human donor.

Donors are individuals who have recently passed away and have chosen to donate their corneas. Eye banks collect and process the cornea tissue before distributing it for use in surgery.

There are different types of cornea transplant surgeries. A surgeon may recommend a certain transplant surgery depending on the underlying cornea problem.

Full-thickness corneal transplant

• Penetrating Keratoplasty (PKP) – This procedure involves removing and replacing all layers of the cornea with donor tissue. It typically requires a more extended recovery period and may take up to a year to reach maximum potential vision.

Partial-thickness corneal transplants

These surgeries involve replacing only specific layers of the cornea rather than the entire structure, which often results in a quicker recovery and fewer complications.

• Deep anterior lamellar keratoplasty (DALK) – This procedure replaces the outer and middle layers of the cornea while preserving the innermost layer.

• Endothelial keratoplasty (EK) – These procedures are designed to replace the corneal endothelium, the innermost layer of the cornea. The surgeon creates a small incision to allow for a small layer of donor cornea tissue to enter the eye. The tissue is then floated to the underside of the cornea using an air or gas bubble. There are two major types of EK, and each is preferable depending on the eye condition.

  • Descemet’s Stripping (Automated) Endothelial Keratoplasty (DSEK/DSAEK) – DSEK/DSAEK uses a thicker piece of tissue.

  • Descemet’s Membrane Endothelial Keratoplasty (DMEK) – DMEK uses the thinnest possible tissue.

Why the procedure Is performed

Corneal transplants are recommended for individuals with conditions that compromise the cornea’s clarity or structure, including:

• Keratoconus, a condition that leads to corneal thinning and distortion

• Scarring from infections or injuries, which can obscure vision

• Fuchs’ dystrophy, a disease that causes corneal clouding due to endothelial cell loss

Possible complications

Like other organ transplants, corneal transplants carry the risk of rejection, where the recipient’s immune system identifies the new tissue as foreign and initiates an immune response. Symptoms of rejection include discomfort, eye redness, increased sensitivity to light and diminished vision. While some cases respond to steroid eye drops, others may require additional treatment or a repeat transplant.

Other risks for a corneal transplant are:

• Bleeding

• Cataracts

• Infection of the eye

• Glaucoma (high pressure in the eye that can cause vision loss)

• Retina detachment (separation of the lining in the back of the eye)

• Loss of vision

• Scarring of the eye

• Swelling of the cornea

Before the procedure

Tell your health care provider about any medical conditions you may have, including allergies. Also, tell your provider what medicines you are taking, even drugs, supplements and herbs you bought without a prescription.

You may need to limit medicines that make it hard for your blood to clot (blood thinners) for 10 days before the surgery. Some of these are aspirin, ibuprofen (Advil, Motrin) and warfarin (Coumadin).

Ask your provider which of your other daily medicines — such as water pills, insulin or pills for diabetes — you should take on the morning of your surgery.

You will need to stop eating and drinking most fluids after midnight the night before your surgery. Most providers will allow you to have water, apple juice and plain coffee or tea (without cream or sugar) up to two hours before surgery. Do not drink alcohol 24 hours before or after surgery.

Cornea transplant surgery is generally performed on an outpatient basis, and patients are typically allowed to return home after the procedure. You will need to plan for someone to drive you home after surgery.

Note: These are general guidelines. Your surgeon may provide you with other instructions.

Day of the procedure

On the day of your surgery, wear loose, comfortable clothing. Do not wear any jewelry. Do not apply creams, lotions or makeup to your face or around your eyes. You will receive eye drops to start off the surgery. Depending on the case, the surgeon will use either local or general anesthesia for pain management. Local anesthesia may include injecting numbing medicine around the eye to block pain and prevent eye movement during the surgery. You may also receive additional medicine from an intravenous line to reduce pain and anxiety.

After the procedure

You will go home on the same day as your surgery. Your provider will give you an eye patch to wear for about 1 to 4 days. If you receive a partial-thickness transplant, you may be asked to lie flat on your back for 24 to 48 hours.

Your provider will prescribe eye drops to help your eye heal, prevent infection and reduce the risk of rejection. Your stitches will be removed at a follow-up visit. Some stitches may stay in place for as long as a year, or they might not be removed at all.

Outlook (prognosis)

Full recovery of eyesight may take up to a year as the cornea heals. Most people who have a successful corneal transplant will have good vision for many years. Some patients may require eye drops for lifelong management. If you have other eye conditions, you may still experience vision loss due to these conditions.

After a transplant, the shape of the cornea may change. You may need glasses or contact lenses to achieve the best vision. Laser vision correction may be an option if you have nearsightedness, farsightedness or astigmatism after the transplant has fully healed.

When to contact a medical professional

Contact your eye care specialist if you experience eye pain, redness, light sensitivity or a decline in vision after your cornea transplant.

Photos and diagrams

References and citations

About Corneal Transplantation. (2024, October 10). American Academy of Ophthalmology. aao.org/eye-health/treatments/about-corneal-transplantation.

Cioffi GA, Liebmann JM. Diseases of the visual system. In: Goldman L, Schafer AI, eds. Goldman-Cecil Medicine. 26th ed. Philadelphia, PA: Elsevier; 2020:chap 395.

Gibbons A, Sayed-Ahmed IO, Mercado CL, Chang VS, Karp CL. Corneal surgery. In: Yanoff M, Duker JS, eds. Ophthalmology. 5th ed. Philadelphia, PA: Elsevier; 2019:chap 4.27.

Gómez-Benlloch A, Montesel A, Pareja-Aricò L, et al. Causes of corneal transplant failure: a multicentric study. Acta Ophthalmol. 2021;99(6):e922-e928. PMID: 33421330 pubmed.ncbi.nlm.nih.gov/33421330/.

McTiernan CD, Simpson FC, Haagdorens M, et al. LiQD cornea: pro-regeneration collagen mimetics as patches and alternatives to corneal transplantation. Science Advances. 2020;6(25):eaba2187 PMID: 32917640 pubmed.ncbi.nlm.nih.gov/32917640/.

Phylactou M, Li JO, Larkin DFP. Characteristics of endothelial corneal transplant rejection following immunisation with SARS-CoV-2 messenger RNA vaccine. Br J Ophthalmol. 2021;105(7):893-896. PMID: 33910885 pubmed.ncbi.nlm.nih.gov/33910885/.

Shah KJ, Holland EJ, Mannis MJ. Corneal transplantation in ocular surface disease. In: Mannis MJ, Holland EJ, eds. Cornea. 4th ed. Philadelphia, PA: Elsevier; 2017:chap 160.

Last reviewed September 26, 2025, by Lauren Jeang, MD, Clinical Assistant Professor, Director of Medical Student Education, UF Department of Ophthalmology.