Since there are many varieties of corneal transplantation, your corneal surgeon will help recommend the best option for you and your condition.
Types
1. Full-thickness (penetrating) keratoplasty is used for many conditions that affect multiple layers of the cornea.
2. Endothelial transplants such as Descemet's stripping automated endothelial keratoplasty are used to treat conditions affecting primarily the back layer of the cornea such as Fuchs endothelial dystrophy and bullous keratopathy. It avoids a large surgical wound, minimizes visual distortion from astigmatism, and provides a more rapid visual recovery than penetrating keratoplasty for certain conditions.
3. Deep anterior lamellar keratoplasty (DALK) can be attempted for conditions such as keratoconus and corneal stromal scar. While technically challenging, DALK attempts to preserve the patient's normal endothelium while replacing all the tissue in front of that layer, thus providing a lower rate of graft rejection. If the delicate back layers of the cornea cannot be preserved during surgery, the procedure is easily converted to a penetrating keratoplasty without the need to reschedule surgery.
4. Keratoprosthesis is a very specialized type of transplant consisting of a hybrid transplant of donor corneal tissue and a rigid plastic central optic. It is reserved for severe corneal and ocular surface disease. For carefully selected patients, it can provide a clear window for vision in an eye that has failed traditional corneal transplants. Strict adherence to postoperative care is a key to avoiding complications, which are more common than after traditional transplants.
