Corneal Transplant
- UK-trained specialist with international fellowship experience
- Prize-winning internationally recognised consultant ophthalmologist
- Elite World College Refractive Surgery Fellow
- Boutique consultant-led service, not corporate volume
- Full spectrum vision correction procedures available
- Referred by fellow surgeons for complex laser surgery cases
What is Corneal Transplantation?
The cornea is the clear, dome-shaped front surface of your eye that plays a crucial role in focusing light and protecting inner eye structures. When the cornea becomes damaged, scarred, or diseased, it can significantly impair vision or cause blindness.
Corneal transplantation involves replacing part or all of the diseased cornea with healthy donor tissue from a deceased donor. Modern techniques allow surgeons to replace only the damaged layers whilst preserving healthy tissue, leading to better outcomes and faster recovery.
The cornea has five layers:
- Epithelium (outer protective layer)
- Bowman’s layer
- Stroma (main structural layer)
- Descemet’s membrane
- Endothelium (inner layer maintaining corneal clarity)
Different transplant techniques address damage to specific layers, allowing for more targeted and effective treatment.
Who Needs a Corneal Transplant?
Common Conditions Requiring Transplantation:
Keratoconus (Advanced Cases): When corneal thinning and bulging cannot be managed with cross-linking, CAIRS, or contact lenses, transplantation may be necessary to restore functional vision.
Fuchs’ Dystrophy: Progressive endothelial cell loss causing corneal swelling, clouding, and vision loss, typically affecting patients over 50.
Corneal Scarring: From previous infections (keratitis), injuries, chemical burns, or failed previous surgeries.
Corneal Dystrophies: Inherited conditions causing abnormal corneal deposits or structural changes affecting vision.
Failed Previous Transplants: When a previous corneal transplant becomes cloudy or fails due to rejection or other complications.
Corneal Oedema: Persistent corneal swelling from endothelial dysfunction that cannot be managed medically.
Post-Surgical Complications: Complications from previous eye surgeries affecting corneal clarity or structure.
Types of Corneal Transplant
1. Penetrating Keratoplasty (PK) – Full Thickness Transplant
What it is: Replacement of the entire cornea, all five layers, with donor tissue. This traditional “full thickness” transplant addresses damage affecting multiple corneal layers.
When used:
- Advanced keratoconus with scarring throughout corneal depth
- Severe corneal scarring from infection or injury
- Multiple failed partial transplants
- Complex corneal pathology
Characteristics:
- Longer recovery time (12-18 months)
- Requires more extensive suturing
- Higher risk of rejection compared to partial transplants
- Excellent visual outcomes when successful
2. Deep Anterior Lamellar Keratoplasty (DALK) – Partial Thickness
What it is: Replacement of the front layers of the cornea (epithelium, Bowman’s layer, and stroma) whilst preserving the patient’s own healthy Descemet’s membrane and endothelium.
Advantages:
- Significantly lower rejection risk (preserving own endothelium)
- Faster recovery than full thickness transplant
- Excellent long-term graft survival
- Maintains structural integrity
When used:
- Keratoconus without endothelial damage
- Corneal scarring limited to anterior layers
- Corneal dystrophies affecting front layers only
Why DALK is preferred when possible: Preserving your own endothelial cells dramatically reduces rejection risk and improves long-term outcomes. This is Mr Mukherjee’s preferred technique for keratoconus and anterior corneal disease.
3. Endothelial Keratoplasty (DMEK/DSEK)
What it is: Selective replacement of only the innermost endothelial layer and Descemet’s membrane, leaving the rest of the cornea intact.
Types:
- DMEK (Descemet’s Membrane Endothelial Keratoplasty): Ultra-thin transplant of endothelium only
- DSEK (Descemet’s Stripping Endothelial Keratoplasty): Slightly thicker graft including some stromal tissue
When used:
- Fuchs’ dystrophy
- Pseudophakic bullous keratopathy (corneal swelling after cataract surgery)
- Endothelial failure from previous surgery or trauma
Advantages:
- Minimal incision (3-4mm)
- Rapid visual recovery (weeks rather than months)
- No or minimal sutures
- Lower rejection risk
- Better refractive outcomes
Femtosecond Laser-Assisted Corneal Transplantation
Revolutionary Precision Technology
Mr Mukherjee utilises advanced femtosecond laser technology to perform corneal transplants with unprecedented precision—a significant advancement over traditional manual techniques using handheld blades.
How Femtosecond Laser Enhances Transplantation:
Superior Precision: The laser creates perfectly matched donor and recipient tissue cuts with micron-level accuracy, ensuring optimal tissue alignment and fit.
Customised Cuts: Ability to create various cut configurations (zigzag, mushroom, top-hat) that increase contact surface area and improve wound healing.
Better Astigmatism Control: Precise, reproducible cuts result in less induced astigmatism and better post-operative vision quality.
Faster Healing: Improved tissue apposition and increased contact area promote faster, stronger wound healing.
Reduced Complications: Eliminates variability of manual technique, reducing risk of irregular cuts or tissue damage.
Enhanced Visual Outcomes: Patients achieve better final vision with less dependence on glasses or contact lenses.
This technology represents the cutting edge of corneal transplantation and is not available at all centres.
The Transplant Journey
Step 1: Comprehensive Evaluation Detailed corneal assessment using advanced imaging (topography, tomography, specular microscopy) to determine disease extent and appropriate transplant technique.
Step 2: Transplant Planning Discussion of transplant type, expected outcomes, risks, and recovery timeline. Placement on the NHS transplant waiting list for donor tissue.
Step 3: Waiting for Donor Tissue Wait times vary (typically weeks to months) depending on tissue availability. You’ll be contacted when suitable donor tissue becomes available.
Step 4: Surgery Performed under local or general anaesthesia in hospital setting. Procedure time varies (1-2 hours) depending on technique. Usually performed as day case or with overnight stay.
Step 5: Recovery & Rehabilitation Regular follow-up appointments to monitor healing, manage medications, and remove sutures when appropriate. Visual recovery timeline depends on transplant type.
Recovery & Timeline
Immediate Post-Operative (First Week):
- Eye pad or shield worn initially
- Moderate discomfort (well-managed with medication)
- Vision very blurry initially
- Intensive eye drop regimen begins
- Avoid rubbing or pressing on eye
- First follow-up within days
Early Recovery (1-3 Months):
- Vision gradually improves
- Reduced drop frequency
- Regular monitoring for rejection signs
- Most normal activities can resume
- Avoid contact sports and heavy lifting
Medium-Term (3-12 Months):
- Continued vision improvement
- Suture removal (if used) typically begins around 3-6 months for PK
- Glasses prescription may change as healing progresses
- DALK/PK: Vision still improving
- DMEK/DSEK: Near-final vision achieved
Long-Term (12+ Months):
- PK/DALK: Final vision typically achieved by 12-18 months
- Final glasses or contact lens prescription
- Ongoing monitoring for rejection (lifelong)
- Continued immunosuppressive drops (duration varies)
Success Rates & Outcomes
Graft Survival Rates:
- DMEK/DSEK: Over 95% at 5 years
- DALK: Over 90% at 10 years
- PK for keratoconus: 85-90% at 10 years
- PK for other conditions: 70-85% at 10 years
Visual Outcomes: Most patients achieve significant vision improvement, though the degree varies based on underlying condition and transplant type. Realistic expectations are essential—whilst many achieve driving-standard vision, not everyone reaches 20/20.
Risks & Complications
Graft Rejection: The most serious risk where the body’s immune system attacks donor tissue. Occurs in 10-30% of cases depending on transplant type. Early recognition and treatment with intensive steroids can usually reverse rejection.
Warning Signs of Rejection (Remember: RSVP)
- Redness
- Sensitivity to light
- Vision decrease
- Pain
If you experience these symptoms, contact your surgeon immediately.
Other Potential Complications:
- Infection (rare with proper care)
- Raised eye pressure from steroid drops
- Wound leak or dehiscence
- Astigmatism requiring glasses or contact lenses
- Cataract development (if not already present)
- Retinal detachment (rare)
- Graft failure requiring repeat transplant
Long-term Considerations:
- Lifelong monitoring required
- Potential need for repeat transplant if graft fails
- Ongoing immunosuppressive medication
- Increased eye vulnerability to trauma
Life After Corneal Transplant
Eye Protection: Wear protective eyewear during sports and activities with trauma risk. Your transplanted cornea is more vulnerable to injury.
UV Protection: Quality sunglasses with UV protection help maintain graft clarity and overall eye health.
Medication Compliance: Follow your prescribed drop regimen meticulously. Missing doses increases rejection risk.
Regular Monitoring: Lifelong follow-up appointments are essential to detect problems early.
Activity Modifications: Avoid high-impact contact sports indefinitely. Swimming allowed after full healing with protective goggles.
Realistic Expectations: Most patients achieve functional vision improvement, though glasses or contact lenses are often still needed. Perfect vision cannot be guaranteed.
Why Choose The Vision Surgeon for Corneal Transplantation?
Specialist Fellowship Training: Mr Mukherjee completed advanced corneal surgery fellowships at Cambridge University Hospital and University Hospital of Wales, providing expertise in the most complex cases.
Femtosecond Laser Technology: Access to cutting-edge laser-assisted transplantation techniques unavailable at most centres, delivering superior precision and outcomes.
Comprehensive Expertise: Experience with all transplant types (PK, DALK, DMEK, DSEK) ensures you receive the most appropriate technique for your condition.
Innovative Approaches: Mr Mukherjee’s background in keratoconus management and corneal disease means comprehensive care from diagnosis through all treatment stages.
Hospital Setting: Procedures performed in NHS hospital environment ensuring highest safety standards and immediate access to emergency care if needed.
Meet Mr. Mukherjee
MBChB(hons) FRCOphth CertLRS
Mr. Mukherjee is one of the UK’s most qualified eye surgeons, offering exceptional care in Colchester. His unique credentials include:
- Prize winning Consultant Ophthalmologist & Clinical Lead – Colchester Eye Centre, ESNEFT
- Specialist in Cornea, Refractive Surgery, and Glaucoma
- Fellow of the Royal College of Ophthalmologists (FRCOphth)
- Elected Fellow World College Refractive Surgery (FWCRS)
- Certificate in Laser Refractive Surgery (CertLRS) – Royal College of Ophthalmologists
Triple Post-CCT Fellowships:
- Cornea & External Disease –Cambridge University Hospital & University Hospital of Wales
- Glaucoma & Minimally Invasive Glaucoma Surgery (MIGS) – King’s College Hospital, London
- Laser eye Surgery & Keratoconus –Emmetropia Eye Institute, Greece
Ready to Transform Your Vision?
Ready to transform your vision? Take the first step towards improving your sight with a comprehensive consultation with Mr. Mukherjee. Discover which procedure is right for you and start your journey to visual independence.