Corneal Transplantalso known as Keratoplasty

A corneal transplant replaces some or all of the eye’s clear front window with healthy donor tissue. Doctors perform the surgery when scarring, swelling, or genetic disease makes the cornea cloudy and light can no longer focus well. More than 80,000 corneal grafts are performed in the United States each year, with success rates exceeding 90 percent for many conditions.[1] The National Eye Institute notes that modern lamellar techniques, which swap only diseased layers, have shortened recovery and reduced rejection risk compared with older full-thickness grafts.[2]

Surgery is done under local or general anesthesia in 30–90 minutes. In penetrating keratoplasty (PK) the surgeon trephines an 8–9 mm “button” of full-thickness tissue and sutures a matching donor button in place. Lamellar options include deep anterior lamellar keratoplasty (DALK) for stromal disease and endothelial techniques (DSAEK, DMEK) for back-layer failure. Endothelial keratoplasty uses a 3 mm incision, air bubbles to position the wafer-thin graft, and often heals without surface stitches.[1] Mayo Clinic data show that surgeons choose the least-invasive method that treats the affected layer while preserving healthy tissue.[3]

Adults or children with vision-limiting keratoconus, Fuchs endothelial dystrophy, corneal scars, or swelling that no longer respond to glasses or specialty contacts may benefit. Candidates need a healthy retina and optic nerve so vision can improve after the graft. Active infection, uncontrolled glaucoma, or severe eye surface disease must be treated first. The AAO advises waiting until the eyeglass prescription fluctuates less than 1 diopter over six months, confirming stable corneal shape on topography.[1] The NEI adds that most recipients are between 20 and 70 years old, but age alone rarely disqualifies someone.[2]

Charges vary by hospital, surgeon, and region. Analyses of U.S. billing data put the average total cost for a one-eye transplant at USD 16,000 – 32,000, including tissue, surgeon, facility, and anesthesia fees.[4] Out-of-pocket expense is usually limited to the deductible and 20 % coinsurance for insured patients, while self-pay packages run USD 10 000 – 18 000 per eye. Mayo Clinic notes that lamellar procedures often qualify for the same coverage and may lower long-term medication costs by reducing steroid needs.[3]

Vision commonly improves from counting fingers to 20/40 or better, and graft clarity can last decades. Endothelial keratoplasty patients reach functional vision in weeks rather than months, and DMEK delivers near-normal optics with less induced astigmatism.[1] A 10-year multi-center study reported 94 % graft survival for DMEK versus 79 % for conventional PK, with fewer rejection episodes.[5] Limitations include months of steroid-drop tapering, possible graft rejection (5–18 %), glaucoma, or infection, and a small risk of graft failure requiring repeat surgery.

Most patients go home the same day. A clear shield protects the eye, and antibiotic-steroid drops are started four times daily. Endothelial grafts require face-up positioning for several hours so the air bubble can press the tissue flat. Stitches from PK stay in for 12–18 months, while DMEK uses no sutures. Routine activities resume in one to two weeks, but strenuous lifting is avoided for a month. Follow-ups occur at day 1, week 1, month 1, then every few months to monitor pressure and graft clarity.[2] Mayo Clinic recommends lifelong annual exams because late rejection can occur even years after surgery.[3]

Surgeons are banking discarded lenticules from SMILE laser procedures as stroma on demand, and pilot trials of acellular bio-engineered corneas have restored sight in keratoconus. A 2024 review highlights endothelial cell therapy and gene-editing approaches that may one day replace donor tissue entirely.[5] Ophthalmology Management reports ongoing U.S. trials of automated DMEK preparation and pre-loaded graft injectors that could streamline surgery and expand access worldwide.[6]

If blurred vision, glare, or painful swelling limits your daily life, request a complete eye exam. A cornea specialist can measure corneal thickness, scan for dystrophies, and explain whether a full- or partial-thickness graft—or a non-surgical option—fits your needs. You can connect with the right specialist on Kerbside for a medical-education consult—no physician-patient relationship will be created.[1][2]