Corneal graft

A penetrating corneal graft performed for advanced
keratoconus. The sutures are interrupted.

A tetonic graft performed for peripheral corneal perforation 
resulting from rheumatoid arthritis-related corneal melt

The patient has a R/L or bilateral corneal graft(s). This may be penetrating or lamellar (look at the edge of the graft for the 
thickness ). The sutures are interrupted / continuous or a combination of both. If the graft is eccentric as in the picture 
above, it is likely to be tetonic (for descemetocele or perforating cornea).

Check the graft for:

  • signs of rejection which may be epithelial, stromal or endothelium. Rejection lines on the endothelium is called 

  • Khodahoust's line. Do not forget to look for keratic precipitates as well as cells or flare in the anterior chamber.
  • security of the suture and any pannus around the suture(s)

Look for the cause for corneal grafts:

  • presence of intraocular lens especially anterior chamber lens suggest pseudophakic bullous keratopathy
  • look at the recipient cornea for signs for corneal dystrophy (this is especially obvious with macular dystrophy 

  • which extend to the peripheral cornea)
  • examine the other eye for signs of dystrophies or keratoconus.
  • in tetonic graft observe the patient's hands for rheumatoid arthritis which may be the cause of peripheral 

  • corneal melt


1. How are donor cornea being stored in the eye bank?

2. How is the cornea assessed before being used for graft?

3. What are the post-operative complications of corneal graft and how would you manage them?

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