[Durgical](https://durgical.com/en/) › [DurgiPedia](https://durgical.com/en/durgipedia/) › [Ophthalmology](https://durgical.com/en/ophthalmology/) › [Eye surgery and procedures](https://durgical.com/en/ophthalmology/areas/surgery/) › Corneal transplant (keratoplasty) and the artificial cornea # 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. Updated Nov 13, 2026 **See it in 3D:** [Cornea](https://durgical.com/en/anatomy/cornea/) ## Key points - Penetrating = full thickness; lamellar = stroma; DSAEK/DMEK = endothelium. - Rejection: redness, light sensitivity, vision drop, pain. - Khodadoust line, keratic precipitates and graft oedema. - Early intensive steroid drops save the graft. - Grafted eyes rupture easily with trauma. ## 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. [Add to my cards (4)](https://durgical.app/estudiar/?add=/en/ophthalmology/corneal-transplant-and-the-artificial-cornea/) ## Connections ## See it in 3D 1 The structures of Durgical's 3D anatomy where it is found. - [Cornea](https://durgical.com/en/anatomy/cornea/) ## Related 4 - [The cornea: clarity, nerves and healing](https://durgical.com/en/ophthalmology/the-cornea-clarity-nerves-and-healing/) - [The slit lamp: what each light shows](https://durgical.com/en/ophthalmology/the-slit-lamp-what-each-light-shows/) - [Corneal topography, tomography and specular microscopy](https://durgical.com/en/ophthalmology/corneal-topography-tomography-and-specular-microscopy/) - [Steroid eye drops: glaucoma, cataract and infection](https://durgical.com/en/ophthalmology/steroid-eye-drops-glaucoma-cataract-and-infection/) ## Related conditions 3 - [Keratoconus](https://durgical.com/en/conditions/keratoconus/) - [Fuchs endothelial corneal dystrophy](https://durgical.com/en/conditions/fuchs-endothelial-corneal-dystrophy/) - [Keratitis and corneal ulcer](https://durgical.com/en/conditions/keratitis-and-corneal-ulcer/) ## In Pharmacology 2 - [Prednisolone](https://durgical.com/en/pharmacology/prednisolone/) - [Corticosteroids (glucocorticoids)](https://durgical.com/en/pharmacology/classes/corticosteroids/) [← All of ophthalmology](https://durgical.com/en/ophthalmology/) 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](https://www.ncbi.nlm.nih.gov/books/NBK592388/) (StatPearls Publishing (NCBI Bookshelf), 2023); [Corneal Graft Rejection](https://www.ncbi.nlm.nih.gov/books/NBK519043/) (StatPearls Publishing (NCBI Bookshelf), 2023); [Artificial Corneal Transplantation](https://www.ncbi.nlm.nih.gov/books/NBK568692/) (StatPearls Publishing (NCBI Bookshelf), 2026); [Descemet Membrane Endothelial Keratoplasty](https://eyewiki.org/Descemet_Membrane_Endothelial_Keratoplasty) (EyeWiki (American Academy of Ophthalmology), 2025). ## **Spotted a mistake?** We are always improving for the community. Tell us what is wrong and our team will review it. Report a mistake Representative model, for educational purposes only. --- Source: https://durgical.com/en/ophthalmology/corneal-transplant-and-the-artificial-cornea/ License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/ophthalmology/corneal-transplant-and-the-artificial-cornea/