PostOp Eyes

Corneal Transplant Recovery: What to Expect

Illustration for corneal transplant recovery

General information about typical recovery, not medical advice. Every eye and every surgery is different, and your surgeon's instructions override anything on this page. Read our full disclaimer.

A corneal transplant, also called keratoplasty, replaces damaged corneal tissue with healthy donor tissue. The National Eye Institute notes that corneal transplants are the most common type of transplant surgery, and that more than 47,000 people in the United States received one in 2014. It is done as outpatient surgery, so you go home the same day, but you cannot drive yourself home.

There is no single corneal transplant recovery. The timeline depends almost entirely on which layers of the cornea were replaced. A full thickness transplant, called penetrating keratoplasty or PK, removes and replaces the whole central cornea and holds it in place with many fine stitches. The American Academy of Ophthalmology says getting complete vision back after PK may take up to one year or longer, and the Cornea Research Foundation of America says visual recovery after PK often takes a year or longer.

The endothelial transplants, DSAEK and DMEK, replace only the thin inner cell layer. They go in through a small incision and need just a few stitches, if any. Instead of stitches holding the graft, an air or gas bubble presses the donor tissue against the inside of your cornea while it sticks down. That is why your surgeon may ask you to lie on your back, face up, for a period after surgery. Because there is no big suture ring reshaping the front of the eye, vision usually comes back much faster. The Cornea Research Foundation of America reports that DSEK patients without other eye problems usually reach about 20/30 or better within a couple of months, and that DMEK gives 20/25 or better vision in about 3 out of 4 patients.

So the short version of why timelines differ so much: PK recovery is paced by stitches and by how the whole cornea reshapes itself as those stitches come out, which takes many months to a year and a half. DSAEK and DMEK recovery is paced by how fast a thin layer of cells clears the swelling out of your cornea, which is usually weeks to a couple of months. Whichever you had, your surgeon's instructions override everything on this page. This page describes what recovery commonly looks like. It does not tell you what is happening in your eye.

The typical timeline

Typical full recovery: Weeks to a few months for DMEK/DSAEK, up to a year or longer for a full thickness (PK) graft. Ranges below are what published guidance describes for most people; your surgeon may set different limits for your eye.

StageWhat to expectRestrictions
Surgery dayDay 0Corneal transplant is outpatient surgery, so you go home the same day. You may be asleep under general anesthesia or awake with numbing medicine and something to help you relax. Afterward your ophthalmologist usually tapes a shield over the eye to keep it covered. Vision through the operated eye is typically very blurry, and the eye may feel sore or scratchy. If you had DSAEK or DMEK, an air or gas bubble is left in the eye to hold the graft up against your cornea, and your surgeon may ask you to lie flat on your back starting right away.You will not be able to drive after the surgery, so arrange a ride home ahead of time. Do not press on or rub the eye. Use the prescribed drops exactly as directed. If you were told to position face up, start that as soon as you get home and take only the breaks your surgeon allows.
First check and first daysDay 1-7You go back to the office the day after surgery so your eye can be checked. For endothelial grafts this visit is largely about confirming the graft is still attached and that eye pressure is not too high from the bubble. The bubble looks like a dark line or shifting edge across your vision and it shrinks over the first days. Vision in the first week is usually cloudy or milky for everyone. Some DMEK patients see surprisingly well quite early, but many do not, and slow early vision is not a bad sign.Keep using drops on schedule. Keep the shield on for sleeping if your surgeon told you to. No rubbing or pressing. If you had DSAEK or DMEK and were given positioning instructions, most of the face up time is in this window. If there is still a bubble in your eye, do not fly or drive to high altitude without clearing it with your surgeon first.
Early healingWeek 2-6For DSAEK and DMEK this is when the cornea usually clears and vision improves the most, since the new endothelial cells are pumping the swelling out. The Cornea Research Foundation of America reports DSEK patients without other eye problems usually reach about 20/30 or better within a couple of months. For PK the eye is quieter now but vision is still poor and distorted, because a full ring of stitches is holding the graft and pulling the cornea out of round.Published guidance for full thickness grafts is to avoid any rigorous physical activity for at least six weeks after surgery, because a broken suture and an open corneal wound can lead to infection or worse. Endothelial transplants need fewer activity restrictions than a full thickness graft, but check with your own surgeon before you resume anything strenuous.
Settling inMonth 2-6After DSAEK or DMEK many people are close to their final vision here and are mostly tapering drops and being watched for rejection. After PK the picture is different. Vision keeps changing as the graft heals, and this is often when selective stitch removal starts. Published patient guidance from the Academy describes suture removal typically beginning around three to six months after surgery, with only about two stitches taken out at a visit, and only once the surgeon judges the wound strong enough.Rubbing the eye stays off the table. Ask before returning to contact sports or anything that could take a hit to the face. Do not stop steroid drops on your own, even if the eye looks and feels perfect, because those drops are what protect the graft.
Late visual recoveryMonth 6-18This phase mostly belongs to PK. As stitches come out in stages, the shape of the cornea shifts, so vision can improve, blur, and improve again. The Academy says getting complete vision back after PK may take up to one year or longer, and the Cornea Research Foundation of America says visual recovery after PK often takes a year or longer. Glasses are usually not finalized until the sutures are out and the shape stops moving. Sometimes the surface stays irregular enough that a contact lens gives the clearest vision. Endothelial transplant patients are usually in routine follow up by now.Keep follow up appointments even when you feel fine, since rejection and pressure problems are found at exams before you notice them. Keep protecting the eye from impact.
Long termYear 1 and beyondA graft is a long term commitment, not a one time event. StatPearls reports approximate graft survival of 70% at 5 years and 50% at 15 years. Rejection can happen at any point, which is why the warning signs matter for life. Many people stay on a low dose steroid drop long term, and your surgeon decides that.With a full thickness graft, published guidance is to be careful for the rest of your life about anything that could injure the eye and break the incision open. There is always some weakness at the wound edge even after the cornea has healed, and ophthalmologists have seen corneal wounds reopen from trauma years later. Avoid boxing and similar activities permanently, and wear protective eyewear for sports.

Day by day

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Common questions

What are the odds my corneal transplant will be rejected?
It depends heavily on the type. The American Academy of Ophthalmology says rejection is a problem for up to 3 out of 10 people who have a full thickness transplant (PK), and that the risk is lower with partial thickness surgeries. The Cornea Research Foundation of America puts full thickness transplants at around a 20 percent rejection risk, DSEK at around 12 percent, and DMEK at less than 1 percent. StatPearls reports a 5 year rejection rate of 7.9 percent for DSAEK in Fuchs cases and a rejection incidence of 2.4 percent over four years for DMEK. Numbers vary by study and by patient, and rejection is not the same as graft failure. Most rejections, if caught early, can be reversed with minimal long term effect, which is why the RSVP warning signs matter.
How long do the activity restrictions last?
For a full thickness (PK) graft, published Academy guidance is to avoid any rigorous physical activity for at least six weeks after surgery, and to permanently avoid activities like boxing that can cause direct trauma to the head and eyes. The Cornea Research Foundation of America adds that patients with a full thickness graft must be careful for the rest of their lives to avoid any injury that could break open the incision, because there is always weakness at the wound edge. Endothelial transplants are lighter: the Foundation notes newer techniques heal faster and require fewer activity restrictions. Not rubbing the eye is permanent for everyone. Your surgeon sets your actual dates.
Do I have to wear a shield at night?
Often yes, at least early on, and the exact instruction is your surgeon's. The Academy notes that an ophthalmologist usually tapes a shield over your eye right after surgery, and that during recovery you should wear eyeglasses or an eye shield to protect the eye. The National Eye Institute gives the same advice about protecting the eye with glasses or a shield. The shield matters most at night because people press or rub their eyes in their sleep without knowing it, and pressure on a fresh graft is exactly what you are trying to avoid.
When do the stitches come out?
It varies. The Academy says the stitches may or may not need to be removed, depending on how quickly you heal, the health of your eye, and the type of stitches used. In an Academy Ask an Ophthalmologist answer, suture removal after a full thickness transplant is described as typically starting around three to six months after surgery, with only about two sutures taken out at a visit, and only once the surgeon feels the wound has healed enough to hold without them. That staged process is one reason vision after PK keeps shifting and may take up to one year or longer to be complete. For DSAEK and DMEK, just a few stitches are needed to close the incision, if any at all.
Will I still need glasses after a corneal transplant?
Usually yes, at least for the sharpest vision. A transplant restores clarity, but it does not aim for a specific glasses prescription. After a full thickness graft the corneal shape keeps changing until the sutures are out, so glasses are typically not finalized until then, and the Cornea Research Foundation of America notes that sometimes the corneal surface is somewhat irregular so a contact lens may be required for the clearest vision. After endothelial grafts, glasses are still common: the Foundation reports DMEK provides 20/25 or better vision for about 3 out of 4 patients, and describes DMEK patients reaching as good as 20/20 with glasses. Your surgeon will tell you when your prescription is stable enough to update.

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