Corneal Transplantation
  Corneal Transplantation

Corneal problems such as Keratoconus, Fuchs corneal dystrophy, post surgery corneal decompensation and infections can compromise the corneal transparency, leading to progressive scarring and loss of vision. This is termed as corneal blindness. Corneal transplantation is the surgical procedure undertaken to cure corneal blindness. It involves replacement of the patient’s diseased cornea with a healthy cornea obtained from deceased human donors who have kindly donated their eyes for this purpose. The UK eye banks are instrumental in providing donor corneas and undertaking a complete health check prior to transplantation.

There are various corneal transplant techniques available based on the type of corneal diagnosis and severity of scarring. They include a full thickness transplant (penetrating keratoplasty), anterior lamellar keratoplasty or posterior lamellar keratoplasty (DSAEK or DMEK).

Treatment options
Cataract surgery
Lens replacement surgery
Premium Intraocular lens
Femtosecond laser assisted surgery
Corneal crosslinking


Human cornea is the clear “window” of the eye. It is approximately 0.5mm thick and 12mm across. It lies in front of the fluid filled anterior chamber of the eye and the coloured iris. It is like the lens of a camera - any opacity or distortion results in a poorly focused image. It has 3 layers: 

1. The thin surface “skin” (or epithelium) 

2. The thick central layer (or stroma) and 

3. The single layer of cells on the back surface (or endothelium) – this last layer is made of cells that are not replaced through life (when damaged the place of the dead cells is taken by enlargement and movement of their healthier neighbours. All of these layers must be clear and smooth for the cornea to work as a window. The cells of the back surface layer (endothelium) pump fluid out of the cornea to maintain its thickness at about 0.5mm – if this layer stops functioning normally the corneal thickness increases and when it reaches about 0.6mm it starts to become opaque (corneal failure or decompensation), at about 0.8mm the cornea becomes waterlogged resulting in blistering of the “skin” (bullous keratopathy) leading to pain in addition to blindness.

There are two principal types: partial thickness (or lamellar) or full thickness (or penetrating). 

Penetrating (full thickness) corneal grafts have been the most widely carried out for all types of corneal disease for 40 years. However this type of graft is only mandatory if there is deep corneal scarring OR when the corneal disease involves both the endothelium AND the stroma . For epithelial and stromal diseases it is carried out because it is easier to replace the whole cornea rather than a layer and because the vision is possibly better after a full graft; the alternative lamellar procedure is the deep anterior lamellar keratoplasty (DALK). The down side of the penetrating graft is the higher risk of transplant rejection, the need for multiple sutures to secure the transplant and delayed visual rehabilitation. In addition, it is difficult to redo a full thickness graft later in life as opposed to a partial thickness corneal transplant. Therefore, for corneal endothelial diseases such as Fuchs dystrophy, penetrating grafts have been superseded by selective lamellar keratoplastytechniques such as DSAEK and DMEK. 

Lamellar (partial thickness) corneal grafts are used for reasons outlined below. They may be anterior OR posterior. 

Anterior lamellar grafts are widely used because of the benefits of greatly reduced risk of rejection and late graft failure and the development of better techniques for doing the surgery. They are only suitable for use in conditions affecting the front layer (epithelium) and central layer (stroma) of the cornea. The down side is that the technique of deep lamellar keratoplasty is technically difficult and if the endothelium is perforated during the surgery, the surgeon needs to convert to a full (or penetrating) graft during the operation. Also the vision following a successful lamellar graft might not match the vision following a successful penetrating graft, although the differences are small. 

Posterior lamellar grafts are a recent innovation. However the results of several thousand patients worldwide have now reported successful outcomes. Technically the posterior lamellar graft is termed Descemet’s stripping automated endothelial keratoplasty (DSAEK) and Descemets membrane endothelial keratoplasty (DMEK). 

The benefits of both DSAEK and DMEK are 

1. It is a small incision technique which is carried out under local anaesthesia through a 5 mm incision, and requires only a few stitches to close the wound. 

2. It leaves the eye much stronger than after a penetrating graft and also eliminates the problems of regular and irregular astigmatism that accompany all penetrating grafts. 

3. It speeds up the recovery period (3 months compared to 12-18 months with penetrating grafts). 

4. It reduces the risk of graft rejection. 

The down side is that the attachment of the transplant to the back of the patient’s cornea might not be total. In this case transplants may dislocate in the first 24 hours in up to 10% of cases and might require minor adjustment in the post operative phase. If this happens it is normally possible to reattach the graft with an air injection under local anaesthesia. Posterior lamellar grafts are prone to immune rejection similar to penetrating grafts and therefore patients should not stop taking steroid eye drops for up to 12 months in the least. DSAEK and DMEK can undergo failure due to endothelial loss and it is possible to redo the procedure with repeat DSAEK procedure. 

• Patients having DSAEK and DMEK can expect stable vision within 2-4 months after surgery but will still require eye drops for 12 – 24 months or more.

• If you are forgetful about your treatment: you must be able to take eye drops for a minimum of 12 months; forgetting to take medication is a frequent cause of graft failure.

You initial visit to see Mr Rajan could be arranged by calling the appointments booking line 01223 266990 at the Spire Cambridge Lea Hospital. Please read the following prior to your visit and bring along A. Spectacles and spectacle prescription from your optometrist B. If you are a contact lens wearer and requiring cataract surgery, then you need to ensure that you had not used your contact lenses for 1 week for soft lenses and 2 weeks for rigid gas permeable lenses prior to your visit. This is aimed at getting accurate measurements of your eye during the consultation visit. You could bring your contact lenses in a contact lens case. C. Your routine medication list and GP referral letter if possible. A GP letter is not mandatory to initiate an eye consultation but always helpful. D. Please allow 1.30 hours for your consultation which would involve various eye tests and biometry by the clinic team prior to seeing Mr Rajan. Your pupils are likely to be dilated with eye drops during the first consultation, so it is not advisable to drive a car or motor vehicle following consultation on the same day. Please make your own arrangements for travel prior to planning a consultation. Mr Rajan will meet you in his consultation room and go through your visual difficulties, He will undertake a detailed eye exam and will discuss treatment options with you on the visit, followed by a written letter to describe the diagnosis and treatment advice. This letter will be copied to your GP and optometrist to benefit you for shared care management of your eye condition in future and for your GP records.
Surgery You will be given a time for admission to the day case unit at Spire Cambridge Lea Hospital. You shouldn’t be driving yourself to this surgery appointment. The nurses at the surgery day case unit will receive you and prepare the eye with appropriate eye drops. Mr Rajan will see you prior to surgeryand complete the consent process. The surgery will take place in the operating theatre under local anaesthetic and sometimes a general anaesthetic might be required based on individual patient profile. If you require a general anaesthetic, this will be discussed and arranged for at the pre-assessment stage with instructions for fasting etc. Mr Rajan will undertake the procedure for you and the nurses will provide all post opinstructions with eye drops prior to discharge from the hospital. Please allow 4-6 hours for the surgery appointment and plan your travel arrangements. If you have a planned in patient stay in the hospital over night, you will be discharged the following day with advice and medications. Post operative period You will receive a post operative appointment to see Mr Rajan within a few days following surgery and during this visit, Mr Rajan will undertake vision and eye examination to ensure that you are recovering well following surgery. You will be advised to use eye drops as per the prescription for up to 4 weeks. It is common to expect blurred vision in the first 48 hours following surgery and vision will gradually improve over 2-3 weeks period. During this time, it is advisable to avoid any visual strain such as prolonged reading, driving or computer use. Regular application of eye drops is essential with good hygiene. There should be no pressure on the operated eye such as eye lid rubbing. You will be given an advice line to the ward and secretary (01223 266940 or 01223 266913) to call for any postoperative concerns and Mr Rajan will advice you accordingly.
What our patients say
01223 266 913
About Us

Cambridge Vision Clinic based in Cambridge, UK features an excellent team of eye care professionals offering a personalised, safe approach to patients with cataract and eye disorders for over 10 years.


Email: info@cambridgevisionclinic.org
Phone: 01223 266 913
Fax: 01223 266 958