Corneal Transplants

Corneal transplant surgery replaces damaged tissue with healthy donor tissue to improve corneal clarity, vision, or comfort. Depending on the affected layers, a cornea specialist may recommend a partial-thickness or full-thickness transplant.

Partial-Thickness Corneal Transplant Surgery

A partial-thickness corneal transplant replaces only the diseased or damaged layers of the cornea. The surgeon preserves the patient’s healthy corneal tissue whenever possible.

Different procedures treat different parts of the cornea:

  • DMEK replaces Descemet’s membrane and the endothelium.
  • DSAEK replaces Descemet’s membrane, the endothelium, and a thin layer of posterior stroma.
  • DALK replaces the anterior and middle corneal layers while preserving the endothelium.


Partial-thickness techniques may provide faster visual recovery, a smaller surgical incision, or a lower risk of certain complications than a full-thickness transplant. However, the appropriate procedure depends on which layers are damaged and whether the remaining tissue is healthy enough to preserve.

A Barnet Dulaney Perkins Eye Center cornea specialist shows a patient which corneal layers may be preserved during partial-thickness corneal transplant surgery.

Types of Corneal Transplant Surgery

Procedeure Tissue Replaced May Be Considered For
DMEK Descemet’s membrane and endothelium Fuchs’ dystrophy and other forms of endothelial failure
DSAEK Descemet’s membrane, endothelium, and a thin layer of posterior stroma Fuchs’ dystrophy, corneal swelling, and endothelial damage
DALK Epithelium, Bowman’s layer, and stroma Keratoconus and corneal disease that has not damaged the endothelium
Full-thickness transplant (PK) All five corneal layers Deep scarring, extensive damage, advanced disease, or a failed previous graft

Full-Thickness Corneal Transplant

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A full-thickness corneal transplant, also called penetrating keratoplasty or PK, replaces all five layers of the damaged central cornea. A surgeon may recommend PK when disease, injury, or scarring affects multiple layers. The surgeon replaces the damaged tissue with screened donor tissue and secures the graft with fine sutures.

Vision usually improves gradually and may take a year or longer to stabilize. The surgeon may adjust or remove sutures during recovery. Glasses or specialty contact lenses may still provide the clearest vision.

Femtosecond Laser-Assisted Keratoplasty

For eligible patients, a femtosecond laser can create matching incisions in the cornea and donor tissue. This precision may improve the graft’s fit and support wound stability. Because the laser requires a sufficiently clear peripheral cornea, specialized imaging helps the surgeon choose between laser-assisted and traditional surgery.

DSAEK Corneal Transplant

Descemet’s stripping automated endothelial keratoplasty, or DSAEK, replaces the unhealthy endothelium and Descemet’s membrane with donor tissue that includes a thin layer of posterior stroma. A surgeon may recommend DSAEK when damaged endothelial cells cause corneal swelling due to Fuchs’ corneal dystrophy, previous surgery, injury, infection, inflammation, or graft failure.

DSAEK is performed through a small incision. The surgeon removes the damaged inner corneal layers and positions a thin donor graft against the back of the cornea. An air or gas bubble supports the graft as it attaches. The graft does not require sutures, although the incision may need one or more. If the graft does not attach fully, another bubble may be placed during a re-bubbling procedure.

Because DSAEK preserves the front and middle corneal layers, it generally provides greater structural stability and faster recovery than a full-thickness transplant. Vision may remain cloudy before improving over several weeks or months. Patients must use prescribed eye drops, attend follow-up visits, and follow temporary restrictions on positioning, activity, altitude, or air travel while the bubble remains.

A Barnet Dulaney Perkins Eye Center cornea specialist examines a senior patient for possible graft rejection symptoms after corneal transplant surgery.

DMEK Corneal Transplant

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Descemet’s membrane endothelial keratoplasty, or DMEK, is a partial-thickness transplant that replaces only Descemet’s membrane and the endothelium. It does not include donor stroma.

DMEK is performed by a surgeon who creates a small incision and removes the unhealthy Descemet’s membrane and endothelial cells. The very thin donor graft is inserted into the eye, unfolded, and positioned against the back of the cornea.

An air or gas bubble holds the graft in place as it begins to attach. The graft itself does not require sutures, although the incision may need one or more small sutures. If the graft does not attach completely, a re-bubbling procedure may be necessary.

DMEK is generally performed as an outpatient procedure. The donor tissue comes from an eye bank and undergoes careful screening before transplantation.

DMEK can provide faster visual recovery than DSAEK or a full-thickness transplant when the rest of the eye is healthy. Because DMEK uses a very thin graft without creating a stromal interface, it may also provide excellent visual clarity and a lower risk of graft rejection than procedures that transplant more tissue. Vision is normally blurry immediately after surgery, but many patients notice improvement within the following weeks.

DALK Corneal Transplant

Deep anterior lamellar keratoplasty, or DALK, replaces the front and middle layers of the cornea while preserving a healthy Descemet’s membrane and endothelium.

DALK may be considered for advanced keratoconus, corneal scarring, or other conditions that affect the stroma without damaging the innermost corneal layers. Preserving the patient’s endothelium eliminates the risk of endothelial graft rejection, although other complications and forms of rejection can still occur.

The surgeon removes the damaged anterior tissue and secures the donor graft with fine sutures. Healing is gradual, and vision can continue changing while the sutures remain in place. Glasses or specialty contact lenses may be needed after recovery.

A senior couple studies colorful prickly pear blossoms in an Arizona desert botanical garden for a Barnet Dulaney Perkins Eye Center corneal transplant surgery resource.

Schedule a Corneal Transplant Evaluation in Arizona

Cloudy, distorted, or declining vision from corneal disease can interfere with reading, driving, working, and enjoying time with the people who matter most. A cornea evaluation can determine what is affecting your vision and whether a transplant or another treatment may help.

Barnet Dulaney Perkins Eye Center provides specialized cornea care for patients across Arizona. Schedule an appointment online to discuss your symptoms, diagnosis, and corneal transplant surgery options

Schedule online Today!

Risks of Corneal Transplant Surgery

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All corneal transplant procedures carry potential risks. These can include infection, bleeding, inflammation, elevated eye pressure, glaucoma, graft detachment, irregular astigmatism, graft failure, retinal detachment, and rejection of donor tissue. The risks differ by procedure and by the health of the individual eye.

Graft rejection does not always mean the transplant will fail. Prompt treatment may help protect the donor tissue. The National Eye Institute advises patients to contact their eye doctor immediately if they develop possible rejection symptoms, including:

  • New or increasing eye redness
  • Eye pain
  • Increased sensitivity to light
  • Cloudy, hazy, or worsening vision


Do not wait for these symptoms to improve on their own. Contact your eye doctor immediately if you develop any symptoms after a corneal transplant.

Corneal Transplant Recovery

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Recovery depends on the transplant technique, the condition being treated, and the health of the rest of the eye. Endothelial procedures such as DMEK and DSAEK generally provide faster visual recovery than DALK or a full-thickness transplant, but every eye heals differently.

After corneal transplant surgery, your care plan may include:

  • Prescription antibiotic and anti-inflammatory eye drops
  • An eye shield, particularly while sleeping
  • Temporary lifting, exercise, bending, or positioning restrictions
  • Restrictions on rubbing the eye, swimming, and wearing eye makeup
  • Frequent follow-up examinations
  • Long-term medication to reduce the risk of graft rejection
  • Glasses or specialty contact lenses after vision stabilizes


Follow all instructions concerning air travel, elevation changes, and nitrous oxide anesthesia if an air or gas bubble was placed in the eye. Read our guide to preparing for a corneal transplant for additional surgery and recovery planning.

FAQ: Corneal Transplant Surgery

A corneal transplant replaces damaged or diseased corneal tissue with healthy donor tissue. The surgeon may replace all five layers or only the layers affected by the condition.

A cornea specialist determines the appropriate procedure by identifying which corneal layers are damaged. Corneal imaging, your diagnosis, previous procedures, and the health of the rest of the eye all influence the recommendation.

Corneal transplant surgery is generally performed as an outpatient procedure. Your surgeon will explain the anesthesia plan, transportation requirements, and what to expect on the day of surgery.

Many corneal transplants use local anesthesia with sedation, although anesthesia choices vary. Your surgical team will select an approach based on the procedure, your health, and your comfort.

Recovery can range from several weeks to a year or longer, depending on the procedure and the health of the eye. DMEK and DSAEK often provide faster visual recovery than DALK or a full-thickness transplant.

You may still need glasses or specialty contact lenses after the cornea heals. A transplant addresses damaged corneal tissue, but it does not automatically correct every source of refractive error or vision loss.

Eye redness, pain, light sensitivity, and cloudy or worsening vision can signal graft rejection. Contact your eye doctor immediately if any of these symptoms develop after a transplant.

Medical insurance may cover corneal transplant surgery when it is medically necessary, but deductibles, copays, coinsurance, network rules, and prior authorization requirements vary. Review the insurance plans accepted by Barnet Dulaney Perkins Eye Center and contact your insurer for details about your benefits.

Barnet Dulaney Perkins Eye Center provides cornea evaluations at select Arizona locations. Visit our Arizona cornea care page or schedule online so the team can direct you to the appropriate specialist and location.