Corneal transplant: what happens, risks and recovery

The cornea is the transparent window at the front of the eye. Moorfields explains that disease or injury can make it cloudy or misshapen, stopping light passing normally. In some conditions only the inner layer, the endothelium, is affected, causing swelling and clouding; in others scarring or distortion involves the full thickness.

A transplant is generally considered when vision cannot be restored in another way. The Dudley leaflet says that if a transplant is offered there is usually no other way of dealing with the problem. Spectacles, special contact lenses, surface treatments and other measures come first for many corneal conditions, and your surgeon will explain why a graft is, or is not, the next step.

The Dudley leaflet outlines at least three types. Full-thickness (penetrating) grafts replace a central disc of every layer. Deep anterior lamellar grafts replace most of the thickness but leave the innermost layers, so those layers must be healthy, and the leaflet notes a theoretical advantage of a lower rejection rate. Inner-layer grafts replace only the endothelium, with the donor tissue held in place by an air bubble.

Moorfields describes the inner-layer approach as using a relatively small incision, with possible advantages over a full-thickness graft: faster recovery, fewer stitches and so less change in corneal shape, and a smaller wound that is less likely to leak or burst after accidental injury. Which type suits you depends on which layers are diseased.

You will have a pre-operative assessment and a review with your surgeon, where the options are discussed again. Moorfields also notes that the hospital is required to share your information with the national blood and transplant service that supplies donor corneas, and asks for your consent for this.

Practical points: arrange someone to take you home, expect an eye pad, and organise time off work. Fasting rules depend on whether you are having local or general anaesthetic, so follow the written instructions.

Moorfields describes endothelial keratoplasty under local anaesthetic, lasting about an hour: the diseased endothelium is removed through a small incision, a disc of donor endothelium is inserted and pressed against the back of the cornea by an air bubble, and you usually lie flat for one to two hours afterwards. One or two stitches are often used and can be removed in clinic.

For a full-thickness or lamellar graft, the Dudley leaflet says part of the abnormal cornea is removed and the donor tissue sewn in with stitches that may stay for more than a year, whereas inner-layer grafts need fewer stitches that come out at three to four months. You are seen by the team afterwards and generally go home the same day.

Moorfields lists rare but serious complications of endothelial grafts, including sight-threatening infection at about 1 in 1,000, severe bleeding, retinal detachment and severe inflammation. Rejection by the immune system and graft failure are the main long-term concerns. Moorfields adds that about 10% of DSAEK and 20% of DMEK grafts shift and need repositioning with an air or gas injection.

The Dudley leaflet adds glaucoma, cataract, astigmatism needing correction, loose or infected stitches and, very rarely, infections passed on from donated tissue, which it says donation protocols make very unlikely. It gives a success rate of 60 to 90% in eyes without previous surgery, lower where there are added risk factors, so treat these as ranges, not promises.

Recovery is slow rather than painful. Moorfields says it can take up to six months for the full improvement after an inner-layer graft, and recommends about two weeks off work, while the Dudley leaflet says vision may be blurred for several months after conventional grafts and suggests two to three months off work, longer with eye-injury risk. Drops are needed for at least six months, and in some cases indefinitely.

The separate timeline page sets this out phase by phase.

Moorfields lists red eye, sensitivity to light, loss of vision and pain as symptoms of rejection, and says rejection needs urgent treatment. The Dudley leaflet says most episodes are reversible if treated early and vigorously. If any of these appear, contact the eye unit or an eye emergency service the same day, and use NHS 111 or A&E if you cannot reach them. Moorfields says rejection remains a possibility throughout your lifetime.

Ask which type of graft is planned and why, how long drops will last, how many visits to expect, what the plan is if the graft fails, and who to ring urgently. Ask about driving, because vision must meet the legal standard in the better-seeing eye.

Corneal transplants are performed within NHS eye services, where donated tissue is supplied nationally, and are also offered privately. Ask any provider about expected waiting time, the plan for aftercare and how to reach an eye emergency service before you start.