I need a corneal transplant to restore my vision.

Corneal diseases and indications for transplantation

Corneal transplantation is recommended for various corneal diseases and injuries that cause reduced vision or pain:

In the early stages of certain diseases, such as keratoconus, less invasive methods such as cross-linking may be applied to strengthen the corneal structure and slow disease progression. However, in advanced cases, transplantation remains the most effective solution.

Pseudophakic Bullous Keratopathy

Bullous keratopathy (BK) is a condition in which small blisters, called bullae, form on the surface of the cornea due to loss of corneal endothelial function.

Bullous keratopathy is most often caused by advanced Fuchs? endothelial dystrophy, or by long or complicated cataract surgery that permanently damages the endothelial cells – the layer that keeps the cornea clear.

What are the symptoms of the disease?
Clinically, BK presents with reduced visual acuity, foreign body sensation, pain, redness, and tearing of the eye. Diagnosis is made by examination under a biomicroscope, which reveals a swollen cornea with reduced transparency and bullae. Measurement of corneal thickness by optical coherence tomography confirms the clinical examination.

Treatment Methods
Treatment includes lubricating eye drops, therapeutic soft contact lenses, and amniotic membrane transplantation to relieve pain and protect exposed nerve endings. The exact mechanism of action of the amniotic membrane is not known, but it has been proven that amniotic membrane transplantation improves epithelial healing by serving as a membrane for epithelial cell growth, preventing inflammatory cell infiltration, and reducing keratocyte apoptosis. Posterior lamellar transplantation is performed in patients when changes have not occurred in the full thickness of the cornea, while penetrating transplantation is performed in cases of irreversibly opaque corneas.

Fuchs’ Endothelial Dystrophy

Fuchs’ endothelial dystrophy (or simply: Fuchs’ dystrophy) is a hereditary disease of the cornea, the transparent front part of the eye. It affects the endothelium—the inner layer of corneal cells, which plays a crucial role in maintaining its transparency. When the number of these cells decreases and they degenerate, fluid accumulates in the cornea, causing blurred vision and other symptoms. Although the disease may be present earlier, it most commonly occurs after the age of 50. Women, who are affected more frequently than men, people with a family history of the disease, and those suffering from other eye diseases or who have had previous eye surgery are at greater risk.

What are the symptoms of the disease?
The most common symptoms include blurred vision (especially in the morning), sensitivity to light, a feeling of something in the eye, vision that improves during the day but worsens and changes from day to day. In later stages, pain and vision impairment that does not resolve may occur, which patients often describe as a constant fog.

Treatment Methods
The good news is that treatment is available, and the approach depends on the stage of the disease. In the early stages, symptoms can be relieved with artificial tears, hypertonic drops, or ointments that draw excess fluid from the cornea. In advanced cases, when corneal opacity is pronounced, surgical treatment in the form of corneal transplantation remains. Today, posterior lamellar corneal transplantation methods, such as DSAEK or DMEK, can be used, where only the inner layer of the cornea (endothelium and Descemet’s membrane) is transplanted. Such a procedure allows for faster recovery and fewer complications.

In patients with developed chronic changes in the remaining corneal layers, penetrating transplantation (full-thickness corneal transplantation) is performed because lamellar transplantation alone is not expected to improve vision due to damage to the other corneal layers.

Herpetic Keratitis

Herpes simplex keratitis (HSK) is the second leading cause of blindness in developed countries after cataracts, primarily due to its recurrent nature. Eight human herpesviruses are known, and HSV-1 causes most cases of herpetic keratitis – between 78 and 98 percent. Depending on the type of tissue affected, herpetic eye disease can affect various parts of the eye, and very often affects the cornea, where it causes primary infection and inflammation. Reactivation of the viral infection and consequent corneal inflammation recur very frequently, leaving behind an opaque corneal scar supplied with blood vessels.

What are the symptoms of the disease?
Superficial herpetic corneal inflammation usually begins unilaterally with sensitivity to light, tearing, redness, foreign body sensation in the eye, and decreased vision. Opacities develop in the epithelium, creating defects of various shapes on the corneal surface, such as dots, branches or stars. Later in the course of the disease, the corneal surface heals, but an opacity forms within the cornea which, if located centrally, prevents good vision. Clinical presentation is important for diagnosis, and virus isolation from a corneal swab is possible. In the first phase of the disease, staining of the corneal surface reveals a typical change in the shape of a branch (or some other form of epithelial defect), and in the later phase, a corneal scar with blood vessels is visible.

Treatment Methods
Treatment includes local and systemic antivirals, debridement, antibiotics, and vitamins. Medications similar to those used for superficial keratitis are used for treatment, in certain cases anterior lamellar (layered) corneal transplantation, while in cases of stromal corneal scars with or without corneal neovascularization, penetrating corneal transplantation is indicated.

Corneal transplantation procedure

Corneal transplantation is a surgical procedure in which a damaged or diseased cornea is replaced with healthy donor tissue to improve vision, relieve pain, or preserve the structure of the eye. It is used when other treatment methods, such as cross-linking or other corneal procedures, can no longer achieve satisfactory results.

Depending on the type and extent of damage, transplantation can be penetrating, in which the full thickness of the cornea is replaced, or lamellar (layered), in which only the affected layer of the cornea is transplanted while preserving healthy tissue. The choice of method depends on the findings and is made by the ophthalmologist after a detailed examination.

Penetrating Corneal Transplantation

Penetrating corneal transplantation (penetrating keratoplasty) is a surgical procedure in which the full thickness of the damaged cornea is replaced with healthy donor tissue. Although more advanced, layered methods are available today, this technique still plays an important role in conditions that affect all layers of the cornea.

It is most commonly used for:

What does the procedure involve?

The procedure is performed by removing the central, damaged part of the cornea and placing a transparent donor graft of appropriate size in its place. The graft is secured with sutures that can (but do not have to) be removed after approximately one year. The operation is most often performed under general anesthesia, and in certain cases can be performed under locally enhanced anesthesia. The procedure itself, including preparation of the donor tissue, takes about 30 minutes.

Recovery and Follow-up

Recovery after penetrating transplantation is gradual and takes longer compared to layered techniques. Within a few days after surgery, the patient achieves better vision than before, but full visual recovery with this corneal transplantation method may take several months. Daily follow-up is necessary for the first 7–10 days. After that, follow-up visits are weekly, then every other week, then monthly, and then every few months to once a year when the condition is stable. Regular follow-up is crucial for timely recognition of any complications and ensuring successful recovery.

Lamellar Corneal Transplantation (DSAEK, UT-DSAEK)

Lamellar corneal transplantation (DSAEK, UT-DSAEK) represents a modern surgical approach in which only the diseased part of the cornea is transplanted, while healthy layers are preserved. This approach allows for more precise treatment with less invasiveness and better functional results. Compared to conventional transplantation, visual recovery is significantly faster. Improvement is typically noticed within a few weeks. At the same time, the risk of complications is lower, and graft rejection is extremely rare. These methods now represent the standard in modern ophthalmology and have been used worldwide for the past decade. The Svjetlost Clinic team performed the first DSAEK and UT-DSAEK operations in Croatia, and among the first in Europe.

DSAEK (Descemet Stripping Automated Endothelial Keratoplasty)
DSAEK is a posterior lamellar keratoplasty used in cases where the anterior part of the cornea is clear and changes are located in the endothelium (inner layer of the cornea).

When is it used?

DSAEK is most commonly used for diseases affecting the corneal endothelium, including:

This method is now one of the most commonly performed transplantation techniques in the world.

Advantages of the Procedure

The advantage is that the largest opening on the eye surface is only 3 mm, and such a small incision preserves the normal curvature of the cornea, which is significant for better vision after surgery, and postoperative recovery is faster, with visual recovery achieved within a few weeks. In penetrating keratoplasty, visual acuity recovery takes several months.

Procedure Course and Recovery

The procedure is most often performed under locally enhanced anesthesia. Compared to conventional transplantation, complications with the DSAEK method are significantly rarer. Due to the minimally invasive approach, the risk of suture-related complications, such as neovascularization and infection, is reduced. Unlike penetrating keratoplasty, only three sutures are placed at the incision sites, and they can be removed as early as the second postoperative month. Graft rejection reactions are ten times rarer compared to penetrating transplantation.

The outcome is influenced by the timeliness of the procedure (earlier surgery yields better results) and the quality and thickness of the graft (the thinner the better). With technological development, this method has been further improved through UT-DSAEK, which uses an even thinner layer of donor tissue, enabling even better visual results.

UT-DSAEK (Ultra Thin Descemet Stripping Automated Endothelial Keratoplasty)

UT-DSAEK is also a posterior lamellar keratoplasty method developed by Italian ophthalmologist Prof. Busin. The difference from conventional DSAEK is in the preparation of the endothelial graft itself, resulting in very thin donor tissue of 100 microns or thinner.

Visual acuity after UT-DSAEK is often 100% and is achieved in a shorter period than after penetrating transplantation or DSAEK. Vision after this procedure is fully comparable to the DMEK technique (a technique in which only the membrane carrying the endothelium and endothelial cells is transplanted). The advantage over DMEK is that the UT-DSAEK graft “detaches” from the transplant site significantly less frequently compared to the DMEK graft, and therefore this is the method of choice for endothelial transplantation at our eye clinic.

Recovery After Corneal Transplantation

After corneal transplantation, regular and detailed postoperative patient monitoring is extremely important. Without regular follow-up and timely therapy adjustments, complications may occur, including graft rejection. The patient must be aware that the success of the operation largely depends on long-term and regular use of prescribed therapy.

In postoperative recovery, all patients use local therapy in the form of a combination of antibiotic and corticosteroid drops and ointments, artificial tears, and eye lubricating gels. In cases of graft rejection, higher doses of corticosteroids are used in the form of enhanced local and/or systemic corticosteroid therapy (in tablet form). Patients are monitored on a daily basis for the first week, then weekly during the first postoperative month, then monthly until the end of the first year, and more frequently if necessary.

Every patient after corneal transplantation must know that a rejection reaction can occur at any time in life and that any decrease in visual acuity, cloudier vision, eye redness, or appearance of suspicious discharge requires IMMEDIATE contact with the eye clinic.

Our clinic and physicians are available 24 hours a day, including weekends, for emergencies and post-operative advice.

Success Rate and Prognosis

Corneal transplantation is considered one of the most successful transplant operations in medicine. The reason for this is the fact that the cornea is an “immunologically privileged tissue,” so rejection reactions occur less frequently than with other transplants.

The success of the operation depends on several factors, primarily the preoperative diagnosis, surgical technique, postoperative monitoring, and patient compliance with regular therapy. The presence of blood vessels in the corneal area and any inflammatory changes also play an important role.

Generally, for low-risk diseases, transplantation success exceeds 90%, while for high-risk conditions it varies between 30 and 70%, depending on the diagnosis and condition of the eye.

The best results are achieved with keratoconus, corneal dystrophies and degenerations (success rate above 90%), as well as with non-vascularized corneal scars and pseudophakic keratopathies (success rate around 80%). In patients suffering from post-keratitic corneal scars, corneal ulcers, or repeat transplantations, success drops to around 60%.

The worst prognosis is for patients with severe corneal burns, highly vascularized scars, very dry eyes, and autoimmune diseases such as Stevens-Johnson syndrome, where success may be 20–30%.

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Frequently Asked Questions