Corneal transplant surgery has come a very long way over the centuries, and modern techniques now offer different solutions for different kinds of corneal disease. Did you know a single donor cornea can restore sight to two people, not one? How did transplant surgery begin, what are the types, and how far has the field really come?
Read on for the answers.
The History of Corneal Transplantation
The original concepts of corneal surgery trace back to the Greek physician Galen. Proposals to treat corneal disease surgically — including keratoplasty — were better developed by the seventeenth and eighteenth centuries, but true scientific and surgical experiments only began in the nineteenth. What we have today is the culmination of pivotal ideas, experimentation, and sheer persistence by inspired individuals over the past 200 years. In 1818, Franz Reisinger began experimental animal corneal transplantation and named it "keratoplasty." Three years later the surgeon Wilhelmus Thorne coined the term "corneal transplant," and three years after that, Samuel Bigger reported a successful corneal transplant in a gazelle. Then progress stalled — held back by limited understanding of antisepsis, anaesthesia, surgical technique, and immunology — and a very long debate followed over animal versus human tissue, and lamellar versus penetrating keratoplasty.
The first successful human corneal transplant came in 1905, performed by Eduard Zirm. Since then, surgeon after surgeon has added to the field's steady accumulation of successes: operating microscopes, fine suture materials, eye banks, and modern advances such as selectively replacing individual corneal layers instead of the full thickness. The field is still advancing today.
💙 A note from Dr. Ahmed Shaarawy's team
In the spirit of sharing positive energy with patients considering corneal transplantation, here is a real story from someone who walked the same path you're considering today. We share it so you know there is a solution — and that the procedure is no longer as difficult as it once was, thanks to the advanced techniques Dr. Ahmed Shaarawy uses.
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Types of Corneal Transplant
Which technique is right depends entirely on the patient. Some patients don't need a full-thickness transplant at all; in some cases only a small portion of the cornea needs replacing. The main types are as follows.
1- Penetrating Keratoplasty (PKP) — Full-Thickness Corneal Transplant
When both the outer and inner layers of the cornea are damaged, the whole cornea is replaced. The surgeon makes a full-thickness cut through the diseased cornea, removes a small disc of corneal tissue, and replaces it with a matched donor button secured with sutures — sutures the surgeon removes at a later stage. Recovery from PKP is relatively long; it can take up to a year for vision to fully stabilise.
2- Endothelial Keratoplasty
Here the diseased posterior layers of the cornea are removed — the corneal endothelium along with a thin protective layer called Descemet's membrane — and donor tissue takes their place. There are two main types.
Type 1: Descemet's Stripping Endothelial Keratoplasty (DSEK / DSAEK)
The donor tissue replaces approximately one-third of the corneal thickness.
Type 2: Descemet's Membrane Endothelial Keratoplasty (DMEK)
The surgeon uses a much thinner layer of donor tissue — the DMEK graft is extremely thin. That makes the procedure technically more demanding than DSEK.
3- Anterior Lamellar Keratoplasty (ALK / DALK) — the Third Type
This procedure replaces only the anterior corneal layer, leaving the unaffected stroma and posterior endothelium intact. When the injury reaches deeper into the stroma, healthy donor tissue is grafted to replace the removed portion — a variant known as DALK, deep anterior lamellar keratoplasty.
4- Keratoprosthesis — Artificial Corneal Transplant
For eyes that are not candidates for a donor transplant, an artificial cornea (keratoprosthesis) can be implanted instead.
Now that we've covered the types, which conditions actually call for surgery?
Indications for Corneal Transplantation:
Corneal transplantation can treat the following conditions:
1- Keratoconus — where the normally dome-shaped cornea takes on a cone-like shape.
2- Genetic disorders such as Fuchs endothelial dystrophy.
3- Corneal scarring.
4- Complications of previous eye surgery.
5- Corneal swelling, thinning, or perforation.
The Best Doctor for All Types of Corneal Transplantation in Egypt and the Arab World
Dr. Ahmed Shaarawy is a lecturer and consultant in cornea and refractive surgery at the Research Institute of Ophthalmology. He holds a PhD and a fellowship in corneal surgery from the Devers Eye Institute in Oregon, USA, where he trained under leading American eye surgeons, and he was the first surgeon in Egypt to perform endothelial keratoplasty (DSAEK) using the S-stamp technique. He has taught that technique to many ophthalmologists and presented it at numerous conferences in the United States and the Arab world. Regarded as one of Egypt's most prominent eye surgeons, he brings a long record of successful operations and a consistent commitment to the latest techniques in eye surgery — and has published a new approach to lamellar corneal transplantation for cases where the technique was previously difficult to apply.
Curious about the treatment steps for keratoconus — one of the leading reasons patients need a corneal transplant? Read this article.
