A corneal transplant restores corneal clarity when medical treatment is no longer enough. It replaces the diseased or cloudy part of the cornea with healthy tissue from a donor, in accordance with the principles governing organ donation in France (presumed consent, no payment, anonymity — articles L.1232-1, L.1211-4 and L.1211-5 of the French Public Health Code, Code de la santé publique).
With modern lamellar techniques (DMEK, DSAEK, DALK), we can selectively transplant the affected layer rather than the full thickness of the cornea, which reduces the risk of rejection and speeds up visual recovery. I personally perform your corneal transplants (DMEK, DALK, penetrating keratoplasty) in Boulogne-Billancourt, on the edge of Paris: indication, pre-operative assessment, surgery in the operating room and long-term post-operative follow-up.
The cornea is the optical window of the eye. When it becomes cloudy or diseased, a transplant restores clarity and vision.
The cornea has 5 essential layers:
Damage to any one of these layers is enough to impair clarity. Modern techniques make it possible to replace selectively the affected layer or layers.
Historically, the full thickness of the cornea was transplanted (penetrating keratoplasty / PK). Today, selective lamellar transplants are preferred:
These lamellar techniques reduce the risk of rejection and speed up visual recovery. Penetrating keratoplasty remains indicated for the most severe conditions.
The choice depends on the condition, the affected layer and the patient's profile. Here is a detailed comparison.
Selective transplant of the endothelium and its basement membrane (a very thin graft, about 10 µm). Indications: Fuchs dystrophy, endothelial decompensation after cataract surgery. Very low rejection rate in published series (Anshu, Ophthalmology 2012), fast visual recovery (often within a few weeks) and excellent optical quality.
Transplant of the endothelium together with a thin layer of posterior stroma. Technically more standardized than DMEK. Similar indications (Fuchs, decompensation after cataract surgery). A good balance between ease of handling and effectiveness, with recovery over a few weeks to a few months.
Selective transplant of the anterior stroma that preserves the patient's own endothelium. Main indication: advanced keratoconus. Major advantage: no endothelial rejection and extended graft longevity (often > 20 years in published series). Vision is usually satisfactory once stabilized.
Transplant of the full thickness of the cornea. Reserved for extensive damage: major traumatic scars, severe infections, chronic hydrops, chemical burns. Higher risk of rejection (estimated at 15 to 20% at 5 years depending on the series) and longer healing, but it remains essential in certain situations.
I perform the three main corneal transplant techniques: DMEK (ultra-thin endothelial transplant, under local anesthesia and sedation), DALK (anterior lamellar transplant for keratoconus, under general anesthesia) and penetrating keratoplasty (PK) for extensive damage (under general anesthesia). I handle the entire care pathway: indication, pre-operative assessment (Anterion imaging, specular microscopy, OCT), surgery in the operating room and long-term post-operative follow-up (corticosteroid therapy, immunological monitoring, rejection prevention).
The diagnosis and the stage of the disease determine the technique and the urgency. Here are the most common situations.
None of these situations is an absolute contraindication to transplantation: above all, they call for appropriate preparation and follow-up.
A corneal transplant requires careful preparation and registration on a waiting list managed by the Agence de la Biomédecine (the French national transplant agency).
Visual acuity, detailed slit-lamp examination, corneal imaging on the Anterion, specular microscopy (endothelial cell count), corneal topography, biometry if combined cataract surgery is planned, macular OCT to rule out associated retinal disease.
A process coordinated with the Agence de la Biomédecine. Waiting times vary widely: a few days in an emergency (perforation, severe infection), several months for elective indications. You are contacted as soon as a suitable graft becomes available.
Review of your medical history, allergies and other health conditions. Choice of anesthesia: local anesthesia + sedation for DMEK, general anesthesia for DALK and penetrating keratoplasty.
A detailed discussion of the expected benefits, risks, alternatives and the follow-up required. You receive and sign the informed consent form. I remain available to answer your questions, at the practice or by phone.
Each transplant is a precise procedure, performed in an operating room under strict quality protocols.
The graft comes from a deceased donor and is supplied by an eye bank. In France, the network is coordinated by the Agence de la Biomédecine. Before surgery, the graft is validated against strict criteria:
For DALK, since the patient's own endothelium is preserved, the graft's endothelial threshold is less critical.
Cloudy cornea, endothelial dystrophy, advanced keratoconus or extensive scarring: a consultation will determine whether a transplant (DMEK, DALK or PK) is right for you.
Book an appointment ↗Every surgical procedure carries risks. Here are the main ones you should know about.
Warning signs of rejection: progressive blurring, eye pain, redness, watering, sensitivity to light. Any of these signs requires an urgent consultation (even at the weekend). Do not wait.
The figures below come from multinational registries and recent prospective studies.
Vision improves gradually. DMEK: often good by 2–3 months. DALK: 3–6 months. PK: 6–12 months, and stabilization may take longer. Some patients continue to improve for up to 24 months.
If a transplant fails (rejection, infection, opacity, endothelial decompensation), a second transplant is possible, and even a third in some situations. The risk of rejection is somewhat higher with each repeat transplant because of cumulative alloimmunization, but results remain satisfactory when the indication is made at the right time.
From diagnosis to long-term monitoring, I am with you at every step.
From a few weeks to several months, depending on medical urgency and graft availability. Emergencies (perforations, severe infections) take priority. Scheduled procedures generally wait several months. The Agence de la Biomédecine manages the national lists.
DMEK/DSAEK: fast recovery, with good vision often by 2–3 months. DALK: 3–6 months. Penetrating keratoplasty: slower, 6–12 months. Vision sometimes continues to improve for up to 24 months. Patience and regular follow-up are essential.
The risk depends on the technique. DMEK: low rejection rate in published series (Anshu 2012). DALK: no endothelial rejection, because the patient's own endothelium is preserved. Penetrating keratoplasty: higher risk, estimated at 15 to 20% at 5 years. Warning signs: progressive blurring, pain, redness, watering, sensitivity to light. Any suspicion warrants a prompt consultation — appropriate corticosteroid treatment can reverse rejection if it is treated early.
Not necessarily. Graft lifespan depends on the technique: DALK can last a very long time (the patient's own endothelium is preserved). DMEK / DSAEK: average longevity often around 10 to 15 years, or longer depending on the initial endothelial condition. Penetrating keratoplasty: variable lifespan. A repeat transplant remains possible if the first one fails.
In France, corneal transplantation is entirely overseen by the Agence de la Biomédecine and reimbursed by French national health insurance. There is no direct cost to the patient for the graft. Surgical and hospital costs are covered by French national health insurance (Assurance Maladie) and standard complementary health insurance (mutuelle).
Not always: the type of anesthesia depends on the technique. DMEK: local anesthesia (peribulbar or sub-Tenon) with light sedation, generally well tolerated. DALK and penetrating keratoplasty: general anesthesia, better suited to the length and precision of the procedure. The choice is confirmed at the pre-anesthesia consultation.
It is rare but possible (rejection, infection, fibrosis, opacity). If the graft fails, a new transplant can be offered, with success rates that remain satisfactory — slightly less favorable than for the first transplant because of cumulative alloimmunization. French national health insurance covers repeat transplants in the same way as the first procedure.
Gradually. Initial eye rest (1–2 weeks), then light activities are allowed. Reading and screens after 1–2 months. Sport and strenuous exertion: 3–6 months depending on the procedure. Work: often possible after 2–4 months. Regular medical follow-up is essential.
A corneal transplant restores corneal clarity when medical treatment is no longer enough. Modern selective lamellar techniques (DMEK, DALK) and rigorous immunological follow-up: a complete assessment determines whether a transplant is indicated and the best strategy for you.
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This page is based on international guidelines and key publications on corneal transplantation. All sources can be verified.
Melles GR, Ong TS, Ververs B, van der Wees J. Descemet membrane endothelial keratoplasty (DMEK). Cornea. 2006;25(8):987-990.
Anshu A, Price MO, Price FW Jr. Risk of corneal transplant rejection significantly reduced with DMEK. Ophthalmology. 2012;119(3):536-540.
Tan DT, Dart JK, Holland EJ, Kinoshita S. Corneal transplantation. Lancet. 2012;379(9827):1749-1761.
Knoeri J, Mhenni R, Friquet C, Hage A, et al. Comparison of optical aberrations in keratoconus with scleral versus rigid gas permeable lenses. Eur J Ophthalmol. 2024;34(2):394-398.
Agence de la Biomédecine. Annual report on corneal transplantation in France (Rapport annuel sur la greffe de cornée en France). Available: https://www.agence-biomedecine.fr
Eye Bank Association of America (EBAA). 2023 Eye Banking Statistical Report. Washington, DC.
The content of this website is for information only and is not a substitute for a medical consultation. Any treatment decision should be made together with your ophthalmologist.