Corneal Surgery (PKP, DSAEK, DALK)

Corneal Surgery (Including Corneal Transplants)

The cornea measures approximately 12 millimeters in diameter and in its normal state allows rays of light to pass through so that they may be focused on the retina in order to see. Many eye conditions affect the cornea and may change its normal transparency. Injuries, infections, inherited conditions, or aging may cause clouding of the cornea and result in decreased or distorted vision.

Sometimes the vision may be improved with glasses, a contact lens or medications. However, in many cases a cornea transplant is necessary to restore sight. On occasion an eye may be painful due to corneal swelling, and the transplant, in addition to restoring vision, will relieve the pain.

The central cloudy portion of the involved cornea is removed at the time of surgery and replaced with a clear cornea donated by a person recently deceased. The entire cornea is not usually transplanted, but only the central portion.

Patients will continue to see their doctor for a year or more after the transplant.

Who Needs a Corneal Transplant?

There are several factors to consider in deciding who could benefit from a cornea transplant and at what time. Our doctors consider the general health of the eye, the pressure inside the eye, the vision in each eye, and the specific condition that caused the decreased vision in the involved eye. Also, any past eye surgery must be taken into account, and any effect it might have on further surgery.

Our doctors perform cornea transplants on patients with the following eye conditions:

  • Keratoconus
  • Fuchs’ Dystrophy
  • Pseudophakic Bullous Keratopathy/Aphakic Bullous Keratopathy
  • Corneal Scar
  • Corneal Perforation
  • Penetrating Injuries
  • Failed Corneal Transplant

Our doctors perform cornea transplants at the Callahan Eye Foundation Hospital and perform pediatric cornea transplants at Children’s Hospital of Alabama. Most of the time, a cornea transplant is an outpatient procedure.

There are several types of cornea transplant procedures:

Full-thickness corneal transplant (penetrating keratoplasty, or PKP)

This involves removing the full-thickness of the central cloudy portion of the involved cornea and replacing it with a clear cornea donated by a person recently deceased. This is often performed for keratoconus, deep corneal scars, corneal perforations, penetrating injuries, failed corneal transplant, and various other indications.

Partial-thickness corneal transplant (descemet’s stripping automated endothelial keratoplasty, or DSAEK)

This involves often removing the back layers of the central cloudy portion of the involved cornea and replacing it with corresponding functioning layers of a clear cornea donated by a person recently deceased. This is often performed for Fuchs’ dystrophy, Aphakic Bullous Keratopathy, Pseudophakic Bullous Keratopathy, and failed corneal transplant. This typically allows for more rapid visual recovery than PKP and there is less incidence of graft rejection.

Partial-thickness corneal transplant (deep anterior lamellar keratoplasty, or DALK)

This can be performed for some cases of keratoconus and superficial corneal scars. This involves removing the front layers of the central cloudy cornea and replacing it with corresponding layers of a clear cornea donated from a person recently deceased. Recovery time may be slightly faster and there may be less incidence of rejection when compared to PKP.


This is a surgical procedure where a severely damaged or diseased cornea is replaced with an artificial cornea. While conventional cornea transplant uses donor tissue for transplant, an artificial cornea is used in this procedure. The surgery is performed to restore vision in suffering from severely damaged cornea due to infections, injuries, burns, and birth defects.

INTACS Corneal Implants

These implants provide a newer option to improve vision, enhance ability to wear contact lenses, and defer cornea transplant surgery in patients with mild to moderate keratoconus. These implants are removable and replaceable and the procedure is minimally invasive. Most insurance companies will cover this procedure if the patient is a candidate.

PTK (phototherapeutic keratectomy)

PTK uses the excimer laser to remove scars, smooth the surface of the cornea, treat recurrent corneal erosions, or change the shape of the cornea affected by surgery or injury. PTK removes the diseased portion of the superficial cornea. The purpose is to improve vision and comfort.