Corneal Transplantation An Overview

  • Soosan Jacob

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The video discusses corneal transplantation in its various forms including penetrating keratoplasty, anterior lamellar keratoplasty and endothelial keratoplasty. It lays a base or foundation for understanding corneal transplantation and its varieties. It includes illustrations and images, and lucid commentary to help the viewer understand the concepts.

The video provides necessary understanding to the viewers about the types of corneal transplantation and the indications for the same. It is useful for young as well as established corneal surgeons, post graduate students, fellows and residents interested in the field, all ophthalmologists, optometrists who are keen to expand their knowledge.


This video provides an overview of corneal transplantation with reference to penetrating keratoplasty, DALK and endothelial keratoplasty.

About The Author

Soosan Jacob

Dr. Soosan Jacob , MS, FRCS, DNB, MNAMS is director and chief, Dr. Agarwal’s Refractive and Cornea Foundation (DARCF) and senior consultant, cataract and glaucoma services, Dr. Agarwal’s Group of Eye Hospitals, Chennai, India. She is a noted speaker widely respected for her innovative techniques and management of complex surgical scenarios. She conducts courses and delivers lectures in numerous national and international conferences; has been the recipient of IIRSI special gold medal, JRS waring medal for editorial excellence, ISRS Kritzinger memorial award, innovator’s award (Connecticut Society of Eye Physicians), ESCRS John Henahan award for young ophthalmologist, AAO international ophthalmologist education award, AAO international scholar award, AAO achievement award, ASCRS Top-Gun instructor award, UKSOS gold medal, AM Gokhale award and oration, Bruce Jackson oration, Harold Stein innovator lecture, Dr. TN Gopinathan Menon memorial oration award, Dr P R Mondal memorial oration award and is also a two time recipient of ASCRS golden apple award. She has delivered keynote lectures at various international and national conferences including the recent (2018) Swiss Society of Ophthalmology annual conference and 2019 annual conference of Ophthalmological Society of Sweden. She has been invited to teach her techniques and innovations by Bascom Palmer Eye Institute, Miami, USA which is the number 1 ranked eye institute in the world.

In addition, Dr Jacob has won more than 50 prestigious international awards for her surgical videos on her innovations and challenging cases at prestigious international conferences in United States and Europe. She has authored 94 peer reviewed publications, more than 200 chapters in 34 textbooks and is editor for 17 ophthalmology textbooks and reviewer for many prestigious journals. She is chair of the multimedia editorial board AAO-ISRS, member ISRS executive committee, associate editor JRS, section editor (refractive surgery) - EyeNet (American Academy of Ophthalmology); council board member – Global Education and Research Society of Ophthalmology; head of cornea committee - Global Education and Research Society of Ophthalmology and is on editorial board of IJO, EyeNet (AAO), EuroTimes, IJKECD, OSN-AsiaPacific, Glaucoma Today, CRST Europe, TNOA-JOSR and Ophthalmology & Therapy.

Dr Jacob has special interest in cutting edge cataract, cornea, glaucoma, complex anterior segment reconstruction and refractive surgery. Her innovations, many of which have won international awards, include anterior segment transplantation, where cornea, sclera, artifical iris, pupil and IOL are transplanted enbloc for anterior staphyloma; suprabrow single stab incision ptosis surgery to enhance postoperative cosmesis; turnaround techniques for false channel dissection during Intacs implantation; glued endo-capsular ring, glued capsular hook and the paper clip capsule stabilizer for subluxated cataracts; stab incision glaucoma surgery (SIGS) as a guarded filtration surgery technique; contact lens assisted crosslinking (CACXL) for safely crosslinking thin keratoconic corneas; endo-illuminator assisted DMEK (E-DMEK), air pump assisted PDEK and host descemetic scaffolding for easier and better surgical results; PrEsbyopic allogenic refractive lenticule (PEARL) inlay for treating presbyopia, corneal allogeneic intrastromal ring segment (CAIRS) for keratoconus and other corneal ectasias; the Jacob modified technique for pre-descemetic DALK as a primary treatment for acute hydrops; sutureless SMILE lenticule assisted resurfacing with interface tattooing for limbal dermoid; white ring sign and the sequential segmental terminal lenticular side cut dissection for safe and effective lenticule extraction in SMILE surgery She has proposed a new classification of descemet’s membrane detachments into rhegmatogenous, tractional, bullous and complex detachments with a suitable treatment algorithm and a new technique of relaxing descemetotomy for tractional descemet’s detachment.

Dr Jacob’s surgeries and surgical techniques have often been editor’s choice in prestigious international ophthalmic websites (AAO/ ONE network, ISRS, Eyetube etc). She has two popular bimonthly columns, “Complications in Cataract and Refractive Surgery” and “Everything you want to know about” in the prestigious Eurotimes magazine published by ESCRS. She is also the first surgeon internationally to be featured in a dedicated webpage by the Eurotimes. She has her own surgical educational YouTube channel: Dr. Soosan Jacob with more than 6000 subscribers. Dr. Jacob is senior faculty for training postgraduate, fellowship and overseas doctors.

Her life and work have been featured on the Ocular Surgery News cover page, “5Q” interview (prestigious cataract and refractive surgery today - CRST), “Sound off” column (CRST) and “One Day in the Life of…” (CRST) and is also the first researcher internationally to be interviewed in the prestigious CRST “Researcher’s Column.”


About this video

Soosan Jacob
Online ISBN
Total duration
11 min
Springer, Singapore
Copyright information
© Producer, under exclusive license to Springer Nature Singapore Pte Ltd. 2021

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Video Transcript


Hi, I’m Dr. Soosan Jacob, director and chief, Dr. Agarwal’s Refractive and Cornea Foundation, Dr. Agarwal’s Eye Hospital, Chennai, India. In this video, I’m going to be giving an overview about corneal transplantation and it’s types.

The cornea is a clear, transparent window of the eye. However, in many conditions the cornea loses its clarity of function, and sometimes a corneal transplantation is required to correct this. Corneal transplantation is one of the most successful and commonly performed solid organ allograft transplantations. Despite not using ABO and HLA typing, the survival rate for corneal grafts is around 90%. Corneal transplantation can return vision to a person with corneal disease as cause for visual loss.

As per 2012 data collected from 148 countries, 184,576 corneal transplants were performed in 116 countries. The utilized donor corneas were obtained from 283,530 corneas stored in 742 eye banks around the world. Corneas were procured in only 82 countries. As per this data, the commonest indication was Fuchs dystrophy, which accounted for 39% of all corneal transplants performed, followed by keratoconus, accounting for 27%. The third commonest indication was sequelae of infectious keratitis, accounting for 20%.

The success of corneal transplantation is due to immune privilege. This is a unique, immunological property of the cornea, and is thought to be due to the absence of blood and lymph vessels in the donor graft and recipient blood, thus blocking formation of immune response. In addition, anterior-chamber associated immune deviation and blockade of the immune effector systems grants immune privilege to the cornea.

Loss of this immune privilege can occur secondary to local host factors such as neovascularization. Loose sutures and suture-associated infections recruit alloreactive cells and cause neovascularization and lymphangiogenesis. They also upregulate MHC molecules.

Each graft rejection heightens the risk of a subsequent graft rejection. Increased antigen presenting cells are seen in excised recipient cornea in inflamed eyes. Corneal transplantation is avoided in actively inflamed eyes, and should be done only after controlling corneal inflammation. Atopy also breaches immune privilege and increases the risk of graft rejection. Other local conditions may also cause an increased risk of rejection.