Corneal Graft (Transplant) Surgery: What It Is—and the New Era of Laser Precision

Simone Klose
Nov 12
3 min read

If the clear “window” at the front of your eye (the cornea) becomes cloudy, scarred, or swollen, your vision can blur the way a dusty windscreen blurs the road. Corneal graft surgery—also called corneal transplantation—replaces the damaged tissue with healthy donor tissue to restore clarity.

The main types of corneal grafts

Penetrating keratoplasty (PK): a full-thickness transplant for deep scars, advanced keratoconus with scarring, or other complex diseases.
Partial-thickness grafts:
- DALK (Deep Anterior Lamellar Keratoplasty): replaces the front layers when the innermost endothelial layer is healthy (often for keratoconus without scarring).
- Endothelial keratoplasties (EK) for “pump” cell failure (e.g., Fuchs dystrophy, post-cataract swelling):
  - DMEK (Descemet Membrane Endothelial Keratoplasty) – thinnest, fastest visual recovery for suitable eyes.
  - Ultrathin DSAEK (UT-DSAEK) – slightly thicker graft, often easier to handle and sometimes preferred in complex eyes.

How do DMEK and UT-DSAEK compare?

In general, DMEK tends to deliver sharper vision and quicker recovery, while UT-DSAEK carries a slightly lower risk of needing extra air (“rebubbling”) after surgery—your surgeon will recommend the best option for your eye. (Nature)

What’s new: femtosecond-laser–assisted corneal grafts

A femtosecond (femto) laser creates ultra-precise, computer-guided cuts in corneal tissue. In corneal transplantation, this precision lets surgeons work more accurately for example determining the depth of a tunnel for a DALK procedure and creating a mushroom shape which gives a better and stronger fit for penetrating keratoplasty. Benefits include

More accurate alignment of the graft
Stronger wound architecture with better sealing
Less postoperative astigmatism and faster early visual recovery.

Some clinical series have shown that femtosecond-laser–enabled penetrating keratoplasty can reduce astigmatism and speed recovery compared with conventional manual techniques, with long-term safety similar to traditional surgery. (PLOS)

Who might benefit from a corneal graft?

Clouding/swelling from endothelial disease (e.g., Fuchs dystrophy)
Scars or thinning after infection, injury, or advanced keratoconus
Irregular shape not correctable with glasses or contact lenses

Your ophthalmic team will evaluate corneal scans, endothelial cell health, eye pressure, lens and retina status, and lifestyle needs to tailor the plan—and whether laser-enabled techniques are likely to add value for you.

What to expect on the day

Before surgery: You’ll have measurements, scans, and a discussion about the graft type (PK, DALK, DMEK/DSAEK) and whether femto laser will be used.
During surgery: Laser steps are quick; the rest of the procedure focuses on safely placing and securing the graft.
After surgery: You’ll use prescription drops (typically antibiotics and anti-inflammatories). Vision improves gradually—faster after endothelial grafts (DMEK/UT-DSAEK) vs. full-thickness PK. Return to everyday activities is staged and guided by your surgeon.

Risks and safeguards

All eye surgeries carry risks. For corneal grafts these include infection, elevated eye pressure, graft rejection or failure, need for additional air (“rebubbling”) after endothelial grafts, and residual astigmatism after full-thickness grafts.

The bottom line

Corneal transplantation has evolved from one “one-size-fits-all” operation into a family of highly customized procedures. Femtosecond-laser–assisted grafts add precision and better wound design, often translating into smoother early recovery and lower astigmatism for the right candidates.

Thinking about whether a corneal graft is right for you?

Our team can examine your cornea, explain which option (PK, DALK, DMEK/UT-DSAEK) fits your eye, and discuss whether femtosecond-laser assistance would add clear benefits in your case.

To book, call +264 81 243 1435 or email bookings@eyedoc.com.na.