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The cornea is the clear covering on the front of the eye which bends, or refracts, light rays that focus on the retina in the back of the eye. It is approximately 0.5mm thick in normal eyes. A certain shape or curvature is required in order for light to focus exactly on the retina, rather than in front of it or behind it. An improperly curved cornea may be corrected surgically or non-invasively to reduce or eliminate the need for eyeglasses or contact lenses. A thorough eye examination and consultation are necessary before a treatment decision can be made.

Corneal transplantation, or keratoplasty, is recommended when curvature is too severe to be treated with other methods, or when extensive damage has occurred due to disease, infection or injury. Common problems that require transplantation are:

* Herpes Simplex Keratopathy- scarring due to herpes virus infection

* Pseudophakic Corneal Decompensation- water logging and greying of the cornea

* Keratoconus- a thining disorder of the cornea, leading to a cone shaped cornea

* Corneal Dystrophies- inherited conditions that lead to opacification

* External tumors
* Traumatic injury- scarring
* Ocular surface diseases
* Chemical burn- scarring

Other types of corneal surgery are performed to remove pterygium and superficial nodules and reduce astigmatism.

Transplantation involves replacing the damaged cornea with a healthy one from a donor (usually through an eye bank). Keratoplasty is the most common type of transplant surgery and has the highest success rate.

Endothelial corneal transplant (DSEK) for corneal oedema

During the procedure, a circular incision is made in the cornea. A disc of tissue is removed and replaced with healthy tissue; these discs may be thin (lamellar keratoplasty) or full thickness (penetrating keratoplasty), the technique used in almost all corneal transplants). Local or general anaesthesia may be used. Over the last 10 years lamellar keratoplasty has developed significantly and nownis the treatment of choice in most corneal transplant surgery. All types of lamellar keratoplasty are available at the Manchester Centre for Vision / Royal Eye Hospital. Deep lammellar keratoplasty (DLK) is used for keratoconus, Deep stromal endokeratoplasty (DSEK) for endothelial transplants and Automated anterior lamellar keratoplasty (ALTK) for anterior scars and dystrophies. Two consultants specialise in this type of surgery.