Endothelial Keratoplasty

A corneal transplant is performed when the cornea (the clear, front window of the eye) has become cloudy or distorted, resulting in a decrease in vision. The diseased part of the cornea is removed and replaced by a cornea provided by an organ donor.

An endothelial keratoplasty is a partial thickness corneal transplant where only the back layers of the cornea are removed and replaced by similar layers from a donor cornea. It is a procedure that is suitable only for people with conditions affecting the back layer (the endothelium) of the cornea, eg. Fuch’s endothelial dystrophy, pseudophakic bullous keratopathy or a failed full thickness transplant.

An endothelial keratoplasty is usually performed under local anaesthetic. Small incisions are made and the back layers of your cornea are removed. The equivalent layers from a donor cornea are then inserted into your eye like a flexible disc. The donor tissue is held in place initially with a bubble of air until it sticks to your own cornea.
Immediately after surgery you will need to remain lying on your back with no pillows for the next 2 hours. This is to give time for the donor tissue to stick to your cornea.

While it is usually not very painful, your eye will feel uncomfortable and light sensitive after surgery. You will be given antibiotic eye drops to reduce the risk of infection for the first month and steroid eye drops which reduce in frequency over time. Depending on your type of work, at least 1 week off work is recommended.

A diagram showing an endothelialkeratoplasty replacing the back layers of the cornea. It is held in place in the initial period by bubble of air

There are numerous risks including:

• Donor dislocation – This is one of the most common complications from an endothelial keratoplasty. It occurs within the first few days after the operation when the donor tissue becomes detached from your cornea. In this situation, you will need to return to the operating theatre to have more air inserted into your eye to help the donor tissue stay in place.
• Rejection – it is important that you stay on your steroid eye drops and you contact the Emergency Department if you suddenly develop a reduction in your vision
• Failure – with time, the transplant may fail and may then need to be replaced
• Raised eye pressure – an increase in your eye pressure leading to glaucoma can occur due to the steroid eye drops. Careful monitoring of your pressure and treatment with pressure-lowering drops can minimise any long term damage from glaucoma
• Infection
• Blindness – the risk of blindness from the operation is very low

Most people will need glasses following surgery.