Current Trends in Corneal Transplantation

Corneal transplantation, as full-thickness transplantation, is an old surgical procedure which has been successfully performed for more than 100 years. However, in a last decade significant changes in surgical technique(s) have been implemented. The reason for such changes is the current trend to replace only the diseased part of the recipient cornea, not the whole cornea. Therefore, if the anterior part of the recipient cornea is opaque, the method of choice to treat such patient is anterior lamellar keratoplasty in which we can preserve the healthy recipient endothelium and thus decrease the chance of graft rejection. If the corneal disease involves posterior part of the recipient cornea, we use posterior lamellar keratoplasty, sparing the anterior part of the recipient cornea and thus improving speed and quality of visual recovery since the problem of high astigmatism caused by corneal sutures is solved. The advantages of lamellar transplantation are numerous: faster visual recovery, decreased rate of corneal graft rejection, preservation of the integrity of the globe, no suture-related problems (in case of posterior lamellar grafts), avoidance of complications related to “opensky” surgery, theoretical possibility to use one donor cornea for two recipients and the use of local instead of general anaesthesia. Of course, there are also some disadvantages of such surgeries: increased early endothelial cell loss, detachment of the posterior lamellar grafts, vascular or epithelial in-growth into lamellar plane, and uncertain fate of lamellar grafts in a long follow-up. In this review the most frequently performed methods of corneal transplantation are presented, together with main advantages and disadvantages of different surgical techniques.