Dr Muataz Mohammad Harara practises ophthalmology with a focus on retinal and vitreous disease. His work includes retinal treatment and injections, cataract and…

Corneal transplantation (keratoplasty) replaces damaged corneal tissue with healthy donor tissue to restore a clear optical pathway. The cornea is the transparent front window of the eye, and any opacity or severe distortion in it prevents a clear image forming on the retina however healthy the retina may be. Transplantation is considered for corneal opacity or severe distortion that glasses and contact lenses cannot correct: advanced keratoconus, scarring after infection or injury, failure of the inner corneal layer causing chronic swelling, or failure of a previous graft. It is important to know that transplantation is no longer a single procedure: there is **full-thickness grafting** and there is **lamellar grafting**, in which only the damaged part is replaced — the front layer or the inner layer — preserving the remaining corneal layers. Lamellar grafting achieves faster recovery and lower rejection risk when the case suits it, and the choice depends on which layer is affected. Recovery expectations need frankness: **vision returns gradually over months**, sutures may stay a long time and be removed in stages, and many patients need glasses or a contact lens after grafting to reach their best vision. What determines long-term graft success is two things: **adherence to prescribed corticosteroid drops for a long period without stopping them on one’s own, and knowing the signs of graft rejection**. Rejection can occur months or years later, and detecting it early and treating it promptly is what saves the graft — so its signs must be memorised: redness, pain, marked light sensitivity, and declining vision.
Procedure steps
- 1
Identifying the affected layer and graft type
Corneal examination, imaging, thickness measurement and assessment of the inner layer determine whether anterior or posterior lamellar grafting suffices or full-thickness grafting is required.
- 2
Assessing the rest of the eye
Eye pressure, retina, optic nerve, eyelids and tear status are assessed, because the graft outcome is limited by the health of the rest of the visual pathway and the ocular surface.
- 3
Donor tissue preparation
Screened and properly stored donor corneal tissue is prepared and cut to the thickness and diameter required by the planned graft type.
- 4
Replacement and fixation
Damaged tissue is removed and donor tissue positioned and secured with fine sutures, or attached with an air bubble in posterior lamellar grafting depending on technique.
- 5
Drops and long-term follow-up
Corticosteroid and anti-infective drops on an extended schedule, with frequent then spaced reviews over years, staged suture removal, and vigilance for any sign of rejection.
Before the procedure
Tell your surgeon about all medications and current drops, any previous eye surgery or graft, and any recurrent eye infection or ocular herpes — this changes the preventive drug plan. Report immune disease, diabetes and eye pressure problems. Treat any dry eye or lid inflammation before grafting, because an unhealthy ocular surface threatens the graft. **Ask explicitly: which graft type will I have and why, when is vision expected, how long will drops continue, and exactly what are the rejection signs and the emergency contact number.** Arrange an escort and expect multiple reviews rather than a single visit.
After the procedure
Never rub or press the eye, wear the protective shield for sleep as prescribed, and protect the eye from injury and contact sports long term. **Use the drops exactly on schedule and do not stop the corticosteroid on your own even after months and improved vision** — stopping early is among the commonest causes of rejection. Avoid swimming, dust and eye make-up until permitted, and attend every follow-up and suture-removal appointment. Do not judge vision early; improvement extends over months and you may need glasses or a lens afterwards. **Seek urgent care immediately for new redness, pain, marked light sensitivity, blurring or declining vision, or discharge — these signal possible rejection, and speed of treatment is what saves the graft.**
Expected duration
45–90 minutes; vision improves gradually over months
Dr Mohammad Akram Hawari combines cataract and lens surgery with paediatric eye care and strabismus correction. His services also include corneal cross-linking …
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