Corneal transplant (keratoplasty) and the artificial cornea
- Topic
A corneal graft replaces all or part of a damaged cornea. Rejection can be reversed if caught early: redness, light sensitivity, blur and pain.
See it in 3D: Cornea
What it is
Keratoplasty replaces diseased cornea with donor tissue. Penetrating keratoplasty replaces the full thickness; deep anterior lamellar keratoplasty replaces the stroma and keeps the patient's own endothelium; endothelial keratoplasty (DSAEK, DMEK) replaces only Descemet membrane and endothelium and recovers fastest. A keratoprosthesis (artificial cornea) is used when repeated grafts have failed or the ocular surface is too damaged for a graft to survive.
Key facts
- Main indications: keratoconus, Fuchs endothelial dystrophy, bullous keratopathy after cataract surgery, scars after infection or trauma, and a failed earlier graft.
- Choice of graft follows the diseased layer: stroma (keratoconus, scars) suits lamellar grafts; endothelium (Fuchs, bullous keratopathy) suits endothelial grafts.
- The cornea has no vessels, so tissue matching is usually not needed; a vascularised or inflamed cornea rejects far more often.
- Rejection signs at the slit lamp: an endothelial rejection line (Khodadoust line), keratic precipitates on the graft and new oedema of the graft.
- Endothelial rejection is the most common and the most dangerous type; the risk is highest in the first years but never disappears.
- Keratoprosthesis needs lifelong drops and follow-up: glaucoma, infection, endophthalmitis, membranes behind the device and extrusion are the main risks.
In clinical practice
- A red, painful, light-sensitive or blurred eye with a corneal graft is rejection until proven otherwise.
- Loose or broken graft sutures collect mucus and invite infection; a white spot near a suture may be an abscess.
- A full-thickness graft wound stays weaker than normal cornea for life: minor blunt trauma can open it as an open globe.
- Long-term steroid drops after grafting can raise eye pressure and cause cataract, so pressure is checked at every visit.
Next step / Initial management
- Red eye, light sensitivity, blur or pain in a grafted eye: same-day ophthalmology; early intensive steroid drops often save the graft.
- Do not stop the patient's prescribed steroid drops while waiting to be seen.
- Loose suture, discharge or a white spot on the graft: same-day review for infection.
- Trauma to a grafted eye: treat as a possible open globe (shield, no pressure on the eye, urgent referral).
- Keratoprosthesis with pain, discharge or loss of vision: emergency referral (endophthalmitis).
Test yourself
Think of the answer, then tap the question to see it.
Which keratoplasty replaces only Descemet membrane and the endothelium, and for which disease is it typical?
Endothelial keratoplasty (DSAEK or DMEK), typically for Fuchs endothelial dystrophy or bullous keratopathy.
Which four symptoms suggest corneal graft rejection?
Redness, light sensitivity, reduced vision and pain.
What slit-lamp sign is typical of endothelial graft rejection?
An endothelial rejection line (Khodadoust line), with keratic precipitates and oedema of the graft.
Why must a patient with a penetrating graft protect the eye from trauma?
The graft wound stays weaker than normal cornea for life and can rupture with minor trauma.
Connections
See it in 3D1
The structures of Durgical's 3D anatomy where it is found.
In Pharmacology2
Educational content; not a clinical guideline and no substitute for assessment by a health professional. For sudden visual loss, severe eye pain, a chemical burn or an eye injury, go to an emergency department at once.
Sources: Penetrating Keratoplasty (StatPearls Publishing (NCBI Bookshelf), 2023); Corneal Graft Rejection (StatPearls Publishing (NCBI Bookshelf), 2023); Artificial Corneal Transplantation (StatPearls Publishing (NCBI Bookshelf), 2026); Descemet Membrane Endothelial Keratoplasty (EyeWiki (American Academy of Ophthalmology), 2025).
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Representative model, for educational purposes only.