Ask the Doc: When is a Corneal Transplant Needed?

The cornea is the clear, dome-shaped surface that covers the front of the eye. It is the eye’s outermost lens, controlling and focusing the entry of light into the eye. A number of conditions may cause the need for a corneal transplant. Those include corneal failure after other eye surgeries, keratoconus (a steep curving of the cornea), hereditary corneal failure (such as Fuch’s Distrophy), scarring after infections (especially after herpes) and rejection following an initial corneal transplant.

If your ophthalmologist decides you need a corneal transplant, your name will be placed on a list at the local eye bank. Before a cornea is approved for transplant, the eye bank tests the cornea for clarity. We receive our corneas from Eversight Illinois Eye Bank.

Corneal transplant surgery is typically done on an outpatient basis. We’re able to remove as little or as much of the cornea as needed. Patients are given eye drops and in some cases, a sedative to help them relax. Local or general anesthesia is used depending on age, medical condition and eye disease.

Last October, I completed training on Descemet’s Membrane Endothelial Keratoplasty (DMEK). DMEK is a surgical procedure that can provide better outcomes for select cornea transplant patients, as well as a lower chance of graft rejection when compared to other transplant methods. It is an excellent treatment option for patients with decreased vision and swollen, cloudy corneas seen in Fuch’s dystrophy, bullous keratopathy, and other causes of poor corneal endothelial function.

There are three generations in the evolution of corneal transplantation, and DMEK is the newest. DMEK offers patients the best visual results of available transplant techniques and the ability to quickly resume routine activities with the lowest risk of vision-threatening rejection episodes. When compared to its predecessors, penetrating keratoplasty (PKP) and Descemet’s Stripping Automated Endothelial Keratoplasty (DSAEK), DMEK is the most anatomically correct repair possible – using one cell layer (the endothelial cells) and a thin membrane that is 15 to 20 microns thick.

DMEK surgery is performed on an outpatient basis. The diseased innermost layer of the cornea is removed and replaced with the corresponding thin layer from a healthy donor cornea. The transplant is held in place by an air bubble, requiring patients to lie on their back with their face directed upward immediately following surgery to keep the bubble in place. The bubble gradually leaves within the first week, and as it goes away, patients do not need to lie flat as often. DMEK surgery is performed after cataract surgery for patients in need of both.

Almost anyone can register to become an eye donor today. The great thing about corneal tissue is that everyone is a universal donor. It doesn’t matter how old you are, how good your eyesight is, what color your eyes are or what type of blood you have. Most people are suitable donors, except those suffering from infections or highly communicable diseases, like HIV or hepatitis. Visit to find out how you can become an eye, organ and tissue donor.”

Dr. Evan Pike, fellowship-trained ophthalmologist and cornea transplant surgeon