The cornea is the clear window at the front of the eye and graft surgery is usually required if the cornea becomes scarred or cloudy (this must not be confused with cataract, which is a clouding of the lens inside the eye).

Corneal graft surgery has been used successfully for over 50 years and modern techniques are continually improving patient outcomes. 

The most common conditions that require corneal grafts include keratoconus and Fuchs Corneal Endothelial Dystrophy. Although full thickness grafts are still often required, some patients benefit from partial thickness grafts (DSEK or DALK) or endothelium only grafts (DMEK).

Graft material needs to come from organ donors, but unlike other transplants corneal grafts usually only require eye drops to prevent rejection and these can often be ceased in the long term. Synthetic (plastic) corneal grafts such as the Boston Keratoprosthesis are only suitable for patients with severely damaged eyes in which a donor graft would not survive. 


Full thickness graft (penetrating keratoplasty; PK)

This is the traditional approach for corneal grafting and it is still arguably the best approach for most patients because it replaces all layers of the cornea. The new graft is stitched into place with extremely fine sutures. It is common for these sutures to require some adjustment after the initial surgery and they often stay in place for up to 2 years. Visual recovery is very slow and frequent appointments are required with the surgeon. It is difficult to get the corneal curvature exactly right so most patients still require glasses or a contact lens to obtain clear vision. Eye drops are usually required for a few years to prevent rejection.

PK before and after

Replacing the front 90% of the cornea (DALK)

This is most commonly performed in patients with moderate to advanced keratoconus but it can also be useful in patients with corneal scarring that is limited to the front part of the cornea. Visual recovery can be very slow but because the inner layer of the patient’s cornea is preserved there are less issues with rejection of the graft and post-operative eye drops can often be stopped within 1 year. 

PK keratoconus

Replacing the back 10% of the cornea (DSEK or DSAEK)

This is performed when the inner layer of the cornea (the endothelium) has failed but the other 90% of the cornea is in good health. The most common cause of endothelial failure is Fuchs Corneal Endothelial Dystrophy, but it can also occur after previously having had complicated cataract surgery. DSEK can have a much faster recovery time than PK with most patients being able to drive safely after only 1 or 2 months. Some patients have a slower recovery and other patients require a second or third operation to get the graft working. Eye drops to prevent rejection of the graft may be required for a year or more. 

Replacing the corneal endothelium only (DMEK)

Just like DSAEK, DMEK is performed when the inner layer of the cornea (the endothelium) has failed but the other 90% of the cornea is in good health. DMEK can have an even faster recovery time than PK or DSEK but the procedure is extremely delicate and relies on a very healthy graft. Not all eyes are suitable for this type of graft and around 20-30% of patients require a further procedure (regraft or rebubble). Despite this, DMEK remains the preferred technique for endothelial repair due to the superior visual recovery and reduced rate of graft rejection. After completing the DMEK surgical training course in Sydney, Dr. Athanasiov became one of only a few surgeons offering this technique in Adelaide.

The cost of corneal graft surgery

Most health funds will cover corneal graft surgery completely. In the absence of private health insurance, out of pocket fees can approach $6000 due to the complexity of the surgery and the cost of the graft plus other specialised equipment that is required. An accurate quote will always need to be arranged with your specific considerations in mind. 





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