A corneal transplant involves replacing damaged or nonfunctional tissue with a replacement from a donor. In 2018 alone, more than 85,000 corneal transplant surgeries were performed. (Learn more)

Cornea transplants are usually successful, but they come with risks. These are organ transplant surgeries, and about one person in three rejects the transplanted tissue within the first five years. You may also face infections, scarring, and bleeding. (Learn more)

You might need a corneal transplant after an injury, but typically, these surgeries are used to help people living with severe eye disease that limits their ability to see. (Learn more)

Insurance companies often cover the cost of a cornea transplant. But expect to prove that no other option can restore your vision. (Learn more)

To prepare for your surgery, you'll need to complete a surgical appointment. Your doctor must assess your eye health and measure your cornea. You'll need to stop taking some types of medication and care for your eyes well before your surgery date arrives. (Learn more)

After surgery, avoid rubbing or pressing on your eyes. Use medications as directed by your doctor. And expect many follow-up visits, so your doctor can ensure that everything is healing properly. (Learn more)

How Does Cornea Transplant Surgery Work?

The cornea is the clear, outer layer of your eye. It helps protect the delicate structures inside the eye from infection, debris, and injury. During a cornea transplant surgery, some or all of this tissue is replaced.

Corneal transplant surgery is relatively common. The Eye Bank Association of America says, for example, that 85,441 corneal transplants happened in 2018 alone.

 Your transplant surgery will typically move forward in these phases:

  • Eye numbing: Your doctor uses a local anesthetic to dull the pain-delivering nerves around and in your eye. Those injections also keep your eye from moving.
  • Sedation: For some surgeries, you're given medication to help you drift into a sleep-like state while the work takes place.
  • Recovery: You'll awaken in a recovery room, and you'll stay there until your doctor deems you ready to go home. Typically, you can leave the same day, but someone must drive you.

The Royal National Institute of Blind People says most cornea transplant surgeries take an hour or two to finish. But expect to spend much longer in the clinic as you prepare for and recover from the procedure.

The American Academy of Ophthalmology says there are many different types of corneal transplants, including:

  • Full thickness. Your doctor removes a circle-shaped piece of your cornea and stitches donor tissue in as a replacement.
  • Partial thickness. Your doctor removes a layer of corneal cells from the front or back of your cornea.

Almost every corneal transplant surgery involves donor tissue. The University of Iowa says that procedures with artificial corneas are available, but they are rare. An estimated 400 to 500 of these surgeries are done worldwide every year. If you're having a corneal transplant, it's likely the new tissue in your eye will come from a donor.

Corneal Transplant Risks & Success Rates

The goal of a corneal transplant is simple. Your doctor uses this technique to replace damaged or diseased tissue. You should emerge with better visual acuity. The organization Saving Sight says more than 95 percent of corneal transplants are successful.

Cornea transplant surgeries can deliver amazing successes. One such case highlighted by the Health Resources and Services Administration involved a child with 20/100 vision in his left eye. That meant the boy could see things at 20 feet that others can see from 100 feet away. After surgery, his vision in that eye measured 20/60. That's a remarkable transformation.

Corneal transplants do come with risks. There is the potential to experience any of these:

  • Bleeding
  • Cataract formation
  • Glaucoma
  • Infections
  • Scarring
  • Swelling
  • Vision loss

Your body may also treat the new tissue as an invader, and when that happens, your immune system can begin to attack. This is tissue rejection, and the U.S. National Library of Medicine says it happens to one patient in three within the first five years of surgery.

itchy eyes

Who Needs a Corneal Transplant?

As we mentioned, corneal transplants are relatively common. Every year, thousands of people have them. But they aren't benign procedures, and they're not right for every condition.

Research from 2017 suggests that most corneal transplants are used to treat two conditions.

  • Fuchs endothelial corneal dystrophy: People with this condition develop corneal swelling. People get blurred vision, and they may struggle with night vision. Blisters can dot the surface of the cornea and cause even more damage.
  • Keratoconus: This condition causes the cornea to thin, and in time, it bulges in the center. The cone shape distorts light as it enters the eye, and vision is distorted.

You may also need a corneal transplant if your eye is injured, and typical therapies to boost healing aren't helping.

How Much Does a Corneal Transplant Cost?High angle view of unrecognizable mature man placing USA Dollar bills into wallet.

Tissue transplant surgeries are complex, and you need an expert's help to complete them. You'll also need the help of donor banks, so you can get the replacement tissue for your eye. Because so many experts are involved, costs can rise quickly. It's not uncommon for these surgeries to come with a price tag in the thousands.

Health insurance plans can offer relief from the high cost of care. It's not unusual for policies to cover this procedure. For example, these insurance providers offer some level of coverage for corneal transplants:

  • BlueCross BlueShield of North Carolina: This organization considers surgery a covered benefit when it's deemed medically necessary. Most patients need a prior review, in which they outline that they need surgery beforehand.
  • Aetna: This organization considers the surgery a covered benefit, but patients should expect to prove that the procedure is a medical necessity. They can't use this solution for any condition, and they might need approval of costs before surgery.
  • Medicare: This organization treats cornea transplants similarly to other organ transplants. If your surgery is deemed medically necessary, your tests, medications, surgery, organ procurement, and follow-up care are covered.

Your surgeon works as an intermediary between you and your insurance company. They will trade paperwork, and together, they will come to an understanding about the plan. In most cases, you won't play an active role in these talks. If you have any questions, talk to your insurance provider as well as your eye surgeon’s office.

Prepare for Your Corneal Transplant Surgery

While your doctor works with your insurance company to address payment issues, you'll work together to prepare your eyes for the procedure to come.

You'll begin with a thorough eye exam. Your doctor will:

  • Assess your eye health. If you discussed transplantation weeks (or months) in the past, your doctor will determine if your condition has grown better or worse.
  • Take measurements. Your doctor needs accurate data to get properly sized donor tissue.
  • Treat other issues. If you have an infection or inflammation, your doctor will address those issues. They must be resolved prior to surgery.

You'll also need to discuss medications. My Health Alberta suggests that many common products can put your surgery's success at risk, including:

  • Aspirin
  • Clopidogrel (Plavix)
  • Herbal remedies
  • Warfarin (Coumadin)

Don't stop taking any prescription medications without your doctor's approval. But be open and honest about what you use, so your doctor can give you the right advice. They will likely advise you to stop using the above medications a week or two before surgery.

An opthamologist is listening to the patient in an exam room.

 

What to Expect After Surgery

A corneal transplant is typically an outpatient surgery, so you head home the same day. You’ll need someone to drive you home after the procedure.

Your recovery isn't complete in one day. At-home care can help to ensure that your eye heals properly and your procedure is a success.

After your surgery, you should:

  • Use medications as directed. Steroid eye drops can keep your immune system from rejecting the new tissue. Antibiotic drugs may keep infections from setting in.
  • Keep all follow-up appointments. The Cleveland Clinic says people typically visit their surgeons 24 to 48 hours after the procedure for a checkup. This ensures everything looks good and no further intervention is needed.
  • Protect your eye. Use goggles or glasses to shield your eye from an injury.
  • Keep your hands away. Pressing or rubbing on your eye can impair healing. If your eye itches, call your doctor.
  • Stay away from work. NHS says people that work in manual jobs should take up to four months off from this type of work. Others can return within a few weeks. Talk to your employer about modifications as your eye heals.
  • Be kind to your eyes. If sunlight, dust, or smoke irritate your eyes, steer clear. Think of your eyes as needing some TLC during this vulnerable time.
  • Follow directions. Don't bathe or exercise until your doctor tells you it's safe to do so.

If you have questions or concerns about your surgery or recovery, call your doctor and ask for help. Don't be afraid to reach out. Your doctor wants you to get well and have a good surgery. You can help the process by asking questions when you're unsure. Get clarity to keep your eyes safe.

Keratoplasty: Reasons You May Need This SurgeryDoctor

If there is a serious condition affecting your cornea, you may need a type of corneal surgery, including a corneal transplant.

There are several types of corneal transplants, called keratoplasty. Each is named differently, depending on the reason for the procedure.

Keratoplasty can help restore your vision. In most versions of this procedure, a donor cornea from an organ donor is used in some way to reshape the cornea, replace damaged tissue, or add to a cornea that is too thin.

These are different types of keratoplasty.

  • Optic keratoplasty: This involves transplanting the cornea with a new donor cornea to remove scar tissue that interferes with vision. Scar tissue can develop from infection or damage to the cornea, such as after a blow to the eye.
  • Refractive keratoplasty: A laser, like those used during a LASIK operation, opens the cornea and removes a section. This may be replaced with a new piece of cornea from an organ donor, adjusted to appropriately reshape the organ to dramatically improve vision. The donor tissue may go in between layers of the cornea (keratophakia) or on top of the cornea (keratomileusis).
  • Tectonic keratoplasty: This is a transplant of corneal material to replace tissue lost to damage or disease.
  • Partial keratoplasty: This is when part of the cornea is damaged and needs to be removed and replaced.
  • Total or penetrating keratoplasty: This is the full removal of the cornea, typically replacing the organ with a donor cornea. The new cornea may be reshaped to improve vision before it is placed onto the patient’s eye.
  • Lamellar keratoplasty: A superficial layer of the cornea is removed, often by a guided laser.
  • Conductive keratoplasty: This form of keratoplasty involves a radiofrequency probe being applied to the periphery of the cornea. The head of this probe causes shrinking of the cornea, making the organ contract and causing the central part of the cornea to become steeper in order to correct farsightedness.

The two most common reasons for keratoplasty are:

  1. Therapeutic, to treat a severe issue with the eye like illness, disease, cancer, or another cause of poor vision.
  2. Cosmetic, to remove an unsightly part of the cornea that does not hamper vision but makes moving through the world embarrassing or difficult in other ways.

If you need to undergo a keratoplasty, it will be important to make sure you have help getting to and from the operation. You will not be able to drive yourself safely, partly due to the anesthesia but predominantly because you will not be able to see clearly and will need to wear an eye patch to protect your eye.

Follow your surgeon’s instructions to promote full healing and attend any follow-up visits after the operation. Because there are so many types of keratoplasty, each operation has a different timeline for complete healing, with penetrating keratoplasty requiring at least a year for full recovery.

There are rare side effects associated with keratoplasty, as there are with any type of eye surgery. These may include:

  • Bleeding from the eye.
  • Glaucoma, or high eye pressure that damages the retina and optic nerve.
  • Retinal detachment, indicated by a rapid increase in floaters in the eye.

Report any of these changes or reactions to your eye doctor immediately.

Endothelial Keratoplasty

If you suffer from certain conditions that damage the inner layer of corneal cells, your ophthalmologist will likely refer you for an endothelial keratoplasty. This procedure removes damaged corneal tissue inside the cornea and replaces it with donor tissue.

Endothelial keratoplasty is a newer form of eye surgery, as it was developed in the early 2000s. The prior best treatment for corneal problems caused by endothelial cell conditions was penetrating keratoplasty. This is an effective procedure, but it requires several months of refractive adjustments to get stable vision.

The inner layers of cells in your cornea may stop functioning properly if you have these conditions:

  • Bullous keratopathy
  • Fuchs’ dystrophy
  • Iridocorneal endothelial (ICE) syndrome
  • Other endothelial cell disorders

There are two basic types of endothelial keratoplasty.

  1. Descemet’s stripping endothelial keratoplasty: This form of EK requires the Descemet membrane to be completely stripped off with specially designed stripping tools. The membrane is then replaced with a partial thickness graft consisting of a transplanted posterior stroma, Descemet membrane, and endothelium.The donor and host corneas are both dissected, and about 20 to 30 percent of the host tissue is implanted. Risk of rejection is much lower than with a full corneal tissue transplant. The healing time is a few months. Most people who undergo this procedure achieve 20/30 vision or better.
  2. Descemet’s membrane endothelial keratoplasty: This form of EK involves partial replacement of the endothelial cells that make up Descemet’s membrane with donor tissue. Recovery time tends to be very fast compared to prior surgeries. It’s typically just a few weeks compared to a few months with other procedures.Many people who undergo this operation achieve excellent visual acuity within a few weeks. Donor tissue is just 5 percent of the original corneal tissue thickness, but three out of four patients achieve 20/25 vision or better.

After either operation, you will be monitored for about two hours to ensure everything is in place. You can then return home with some assistance. You’ll have follow-up exams on the day immediately after your operation and two days after that.

With both procedures, along with earlier versions of endothelial keratoplasty, the surgeon removes the damaged tissue from inside the cornea. They then implant healthy donor tissue, positioning it properly so it will heal without forming scar tissue and affecting vision.

Advantages of endothelial keratoplasty, compared to older surgeries to manage corneal problems, include:

  • The eye is less prone to injury.
  • The surface of the eye is stronger.
  • Recovery time is much faster for both procedures, but especially with DMEK.
  • There are minimal restrictions on activities during healing time.
  • There are few changes needed for glasses prescriptions.

Although endothelial keratoplasty is a newer type of surgery, both DSEK and DMEK appear to have better rates of healing, fewer instances of donor tissue rejection, and better overall outcomes for those who need it.

References

2018 Eye Banking Statistical Report. Eye Bank Association of America.

Corneal Transplant. Royal National Institute of Blind People.

What to Expect When You Have a Corneal Transplant. (September 2019). American Academy of Ophthalmology.

Eye Donor Awareness: Frequently Asked Questions. (October 2018). University of Iowa Hospitals and Clinics.

Important Information About Cornea Donation. Saving Sight.

Corneal Transplant Lets Boy See the World. Health Resources and Services Administration.

Corneal Transplant. (August 2018). U.S. National Library of Medicine.

The Evolution of Corneal Transplantation. (December 2017). Annals of Transplantation.

Corporate Medical Policy. (June 2019). BlueCross BlueShield of North Carolina.

Corneal Remodeling. (May 2019). Aetna. http://www.aetna.com/cpb/medical/data/1_99/0023.html

Organ Transplants. Medicare.gov.

Cornea Transplant. (May 2018). Mayo Clinic.

Corneal Transplant (Full Thickness): Before Your Surgery. (July 2018). My Health Alberta.

Cornea Transplant: Procedure Details. (February 2018). Cleveland Clinic.

Afterwards: Cornea Transplant. (April 2018). National Health Service.

Keratoplasty. Medical Dictionary; The Free Dictionary.

Conductive Keratoplasty. Medical Dictionary; The Free Dictionary.

Corneal Transplants. (July 2019). National Eye Institute (NEI).

Endothelial Keratoplasty: From DLEK to DMEK. (January 2010). Middle East African Journal of Ophthalmology.

Endothelial Keratoplasty (DSEK & DMEK). (2017). Corneal Research Foundation of America.

Descemet Stripping Endothelial Keratoplasty. (February 2020). American Academy of Ophthalmology (AAO).

Descemet Membrane Endothelial Keratoplasty. (April 2016). Eye Rounds, Ophthalmology and Visual Sciences, University of Iowa Healthcare.