💙 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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Everything You Need to Know About Corneal Transplant Surgery
The cornea is the clear layer at the front of the eye — the eye's primary lens. Its job is to focus incoming light so you can see clearly. When the cornea is damaged, it may need to be replaced through corneal transplant surgery.
Dr. Shaarawy removes all or part of the damaged cornea and replaces it with healthy donor tissue. The replacement cornea comes from individuals who chose to donate their corneas after death, and is imported from accredited eye banks in the United States.
A corneal transplant — also called corneal grafting — can restore vision, reduce pain, and improve the appearance of a damaged cornea, which can otherwise give the eye a white, opaque look.
Who Might Need a Corneal Transplant?
Light passing through a damaged cornea scatters, producing blurred, hazy vision. This can result from conditions such as:
- Corneal scarring from injury or infection
- Corneal ulcers from infection
- Keratoconus, where the cornea bulges outward into a cone shape
- Corneal thinning or swelling (edema)
- Inherited corneal diseases such as Fuchs dystrophy
- Complications from previous eye surgery, such as cataract removal
Dr. Shaarawy will discuss the specific procedure best suited to your case.
Main Types of Corneal Transplant
1. Penetrating Keratoplasty (PKP)
This is the full-thickness transplant: the entire cornea is replaced with a healthy, clear donor cornea. It's performed when the cornea has sustained severe, vision-affecting damage and no surgical alternative exists. The procedure can be done under local or general anesthesia and takes about an hour. Roughly 8 mm of the cornea is replaced — using either a trephine or a femtosecond laser — then secured with sutures, typically 16 stitches. Vision will be blurry for several days after surgery, and the sutures usually stay in place for about a year.
2. Deep Anterior Lamellar Keratoplasty (DALK)
In DALK, about 99% of the cornea is replaced with donor tissue — but not the entire thickness, as in a full PKP. It's a technically demanding procedure: the surgeon separates the back layers of the cornea (Descemet's membrane and the endothelium) and preserves them, replacing only the rest of the corneal layers. This technique serves as an alternative to penetrating keratoplasty whenever those back layers are still healthy. The donor tissue is then secured with sutures.
A key advantage of DALK is that the rate of graft rejection approaches zero, and steroid drops can typically be tapered earlier. One of its most common indications is keratoconus.
3. Endothelial Keratoplasty (EK) — Posterior Lamellar Transplant
Here only the back (endothelial) layer of the cornea is replaced — Descemet's membrane and the endothelium. To put it simply, it's the opposite of DALK.
EK is also a highly specialized procedure with two main variants. The first, DSAEK, replaces Descemet's membrane and the endothelium along with a thin layer of corneal stroma. The second, DMEK, replaces only Descemet's membrane and the endothelium. Both follow the same overall strategy for treating diseases of the cornea's back layer — most commonly endothelial decompensation after cataract surgery, which can disrupt the back of the cornea.
Why does that layer matter so much? The endothelium is what keeps the cornea clear, pumping fluid out and preventing swelling. When the endothelial cell count falls too low — through disease or damage — the cornea begins to swell and vision turns hazy.
The surgery is performed under local or general anesthesia through a small incision, about 2 mm, in the eye. The damaged endothelial cells and their layer are removed, and Dr. Shaarawy replaces them with healthy donor endothelial tissue, held in place with an air or gas bubble. After surgery, the patient lies flat on their back for about two hours, then keeps the face directed upward so the gas bubble stays in position — it's the bubble that helps the donor tissue adhere where it belongs.
During his PhD fellowship at Legacy Devers Eye Institute in the United States, Dr. Shaarawy worked alongside Dr. Mark Terry on these complex surgeries, and he was the first surgeon to perform DMEK using the S-Stamp technique in Egypt — a technique developed at Legacy Devers itself, where he trained. He has presented this work at numerous local and regional conferences.
*In severe cases, an artificial cornea (keratoprosthesis) may be implanted (as shown above) to avoid graft rejection.
Recovery
Some blurriness after a corneal transplant is normal until the eye fully heals. Mild redness and light sensitivity are expected too, and you may notice itching for a few days — though some patients have no discomfort at all.
Dr. Shaarawy will prescribe eye drops to reduce inflammation and lower the risk of infection, and other medications may be added to ease any pain. He will examine the eye on the first day after surgery, several times during the following two weeks, and a number of times over the first year. Please follow all instructions carefully.
Keep in mind that the cornea has no blood supply, so it heals slowly. If sutures need to come out, the surgeon typically removes them after one year.
Possible Complications
Corneal transplantation is broadly considered a safe procedure — but as with any surgery, complications are possible. The body's immune system may attack the donor cornea, known as graft rejection. In most cases this can be treated with drops or medication, but it requires vigilance on your part: any noticeable drop in vision should prompt an immediate appointment, because rejection caught early is much easier to reverse. In some cases a repeat transplant is needed — often replacing only the back layer this time, using DSAEK or DMEK, which carry a much lower rejection rate.
Other possible complications include:
- Infection
- Bleeding
- Elevated intraocular pressure (glaucoma)
- Lens opacity (cataract)
- Corneal swelling
Outcomes and Success Rates of Corneal Transplant
Most patients regain functional vision relatively quickly, and corneal transplant has the highest success rate of any organ transplant in medicine — over 90%, although every case is different. It may take several weeks, or even up to a year, for vision to fully stabilize.
You may need updated glasses or contact lenses with astigmatism correction, since a transplanted cornea is rarely perfectly spherical and can leave some residual astigmatism. After the first year, follow up with Dr. Shaarawy once or twice a year.
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