Why different types of corneal transplantation?

With modern technology and the evolution of techniques we are fortunate to have a variety of corneal transplantation procedures available, allowing us to address the underlying condition with the procedure that is most appropriate, safest and provides the best outcome.

What is penetrating keratoplasty?

Penetrating keratoplasty (PK) involves replacing all the layers of the affected cornea with a full thickness transplant. It is usually carried out when the condition is affecting more than one layers or the full thickness of the cornea, e.g in very advanced keratoconus or following trauma.

DSEK, DALK

What is Descemets stripping endothelial keratoplasty?

Endothelial keratoplasty, including Descemets stripping endothelial keratoplasty (DSEK), is currently the gold standard in the management of Fuchs endothelial dystrophy and bullous keratopathy. It involves the selective replacement of the dysfunctional inner layer of the cornea with a thin layer of transplant cornea that has healthy endothelial cells.

DSEK has several advantages over full thickness penetrating keratoplasty (PK) including:

  • keyhole surgery allows faster improvement in vision

  • surgery is carried out under local anaesthetic and in less than an hour; the risks of a general anaesthetic are thus avoided

  • reduced risk of serious complications

  • reduced risk of needing high-power glasses or contact lenses after surgery

What is deep anterior lamellar keratoplasty?

In deep anterior lamellar keratoplasty (DALK)​ 90% of the affected cornea is replaced with

the transplant cornea, leaving you with your own endothelial layer. The commonest indications for DALK are keratoconus and corneal scars.

DALK has several advantages over full thickness penetrating keratoplasty (PK) including:

  • reduced risk of graft rejection

  • sutures can be removed sooner

  • reduced risk of serious complications

  • faster visual recovery

DSEK, DALK