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Advances in corneal transplantation

Eye volume 39, pages 2497–2508 (2025)Cite this article

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Abstract

For many corneal diseases, transplantation is the gold standard for curative treatment and restoration of vision. Penetrating keratoplasty (PKP), performed by Zirm in 1905, was the first successful corneal transplantation procedure. Since then, relentless advancement in the field has occurred, most importantly with the development of deep anterior lamellar keratoplasty (DALK), Descemet stripping automated endothelial keratoplasty (DSAEK) and Descemet membrane endothelial keratoplasty (DMEK), which have been rapidly increasing in usage and are poised to take over PKP in prevalence and effectiveness in treating specific stromal and endothelial pathologies. The biggest issues currently facing this field are the lack of availability of donor corneas and lack of accessibility of the procedure to many areas of the world. Recent and future advancements are focused on substitutes to increase the amount of graft material for use and technological developments to streamline keratoplasty techniques, making them more effective, easier to perform and associated with less complications. Bio-engineered corneas, cell-based therapies and regenerative medicine can create grafts through various mechanisms: acellular, synthetic scaffolds and medical therapies to promote endogenous cell regeneration or exogenous cultivation of corneal tissues from stem-cells. Keratoplasty has also been refined by the introduction of femtosecond laser (FSL), which when combined with intra-operative optical coherence tomography (iOCT) allows for finer cuts and novel techniques which can improve the outcomes from PKP, DALK and DMEK.

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Fig. 1: Indications for lamellar keratoplasty.
Fig. 2: Timeline of advancements in corneal transplantation.
Fig. 3: Different graft insertion methods for DSAEK.
Fig. 4: Diagram illustrating the differences between DSAEK, UT-DSAEK and DMEK.
Fig. 5: Graph showing percentage prevalence of PKP (PK), ALK and PLK (EK) as observed in the Singapore Corneal Transplant Study from 2008 to 2017.
Fig. 6: Diagram illustrating steps in cultivation and injection of CECs.
Fig. 7
Fig. 8
Fig. 9

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Authors and Affiliations

  1. Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore

    Christopher Tay

  2. Bharathi Eye Hospital, Kadapa, India

    Harika Reddy

  3. Singapore National Eye Centre, Singapore, Singapore

    Jodhbir S. Mehta

  4. Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore

    Jodhbir S. Mehta

  5. Duke-NUS Medical School, Singapore, Singapore

    Jodhbir S. Mehta

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  1. Christopher Tay
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  3. Jodhbir S. Mehta
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JSM conceived the idea for the paper and gave the talk that the paper is based on. CT performed background research and wrote the paper. HR and JSM did proofreading and editing.

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Tay, C., Reddy, H. & Mehta, J.S. Advances in corneal transplantation. Eye 39, 2497–2508 (2025). https://doi.org/10.1038/s41433-025-03898-9

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  • DOI: https://doi.org/10.1038/s41433-025-03898-9

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