Corneal Transplant Success Rate: Graft Survival, Rejection and Results

Medically reviewed by Dr. Fouad El Sayyad, Consultant Ophthalmologist — Cornea, Cataract & Refractive Surgery · Last reviewed: October 2026

Quick answer: According to published evidence, most corneal transplants succeed, and many grafts stay clear for ten years or more. Large recent studies report that about three-quarters to nine in ten grafts done for Fuchs dystrophy are still clear at ten years, depending on the technique. Success depends mainly on the reason for the transplant, the health of the rest of the eye and early treatment of rejection.

Key Takeaways

• A successful transplant means a clear graft and useful vision; many patients still need glasses or contact lenses.
• Published results are best in keratoconus and Fuchs dystrophy and less good in eyes with glaucoma, previous failed grafts or a damaged ocular surface.
• Systematic reviews show that DMEK gives the sharpest vision, with a higher chance of needing a second air bubble than ultrathin DSAEK.
• Rejection is the main cause of failure after PK, and lamellar transplants (DALK, DMEK) have lower rejection rates.
• A graft that fails can usually be replaced with another transplant.

What Does “Success” Mean After a Corneal Transplant?

Success has two parts: whether the graft stays clear (graft survival), and whether the patient gains useful vision. The two are not the same. A clear graft can still leave astigmatism that needs glasses or a contact lens, and vision can be limited by other conditions such as glaucoma or macular disease. Before surgery, I examine the whole eye so that we agree on a realistic goal.

What Does the Published Evidence Show?

The figures below are global, evidence-based results from large published studies and systematic reviews, not the results of a single surgeon.

What this means in practice: the published evidence shows a trade-off. Endothelial transplants (DMEK and DSAEK) give much faster and better vision, while full-thickness PK grafts in some long-term studies stayed clear for longer. For most patients with Fuchs dystrophy, the faster and better visual recovery makes DMEK the preferred choice. For keratoconus, DALK gives similar vision to PK with fewer rejection episodes, because the patient’s own inner cell layer is kept.

What Affects the Success of a Corneal Transplant?

• The reason for the transplant: keratoconus and Fuchs dystrophy have the best outcomes; corneal swelling after previous surgery, infection and chemical injury have lower success rates.
• Blood vessels in the cornea: vessels growing into the cornea raise the risk of rejection.
• Previous failed grafts: each repeat graft has a higher risk of rejection.
• Glaucoma and glaucoma surgery: associated with lower graft survival and faster loss of endothelial cells in published studies.
• The ocular surface: dry eye, eyelid disease or surface damage can stop the graft surface from healing well.
• Following the aftercare: using the steroid drops, attending follow-up and reporting symptoms early.

What Is Graft Rejection, and How Is It Treated?

Rejection happens when the body’s immune system recognises the donor tissue as foreign and attacks it. Published reviews show that it is the main cause of failure after PK, and that lamellar transplants have lower rejection rates: DALK keeps the patient’s own inner cell layer, which cannot be rejected. When rejection is caught early, it can often be reversed with intensive steroid drops, so it is important to know the signs.

Contact us the same day if you notice any of these, even years after surgery:

• Redness of the operated eye
• Sensitivity to light
• Pain or discomfort
• Hazy or reduced vision

How Long Does a Corneal Transplant Last?

There is no fixed lifetime. Many grafts stay clear for ten years or more, and some for decades. The donor endothelial cells slowly decrease over time, and in some eyes the graft eventually becomes cloudy. Regular follow-up lets me detect rejection, raised eye pressure or other problems early, which helps the graft last longer.

What Happens If a Graft Fails?

A failed graft can usually be replaced. Depending on the eye, the repeat transplant may be a DMEK or DSAEK placed under the old graft, or a new PK. Repeat grafts have a higher risk of rejection than first grafts, so the aftercare is often more intensive. Read when a corneal transplant is needed.

When Does Vision Improve After a Corneal Transplant?

After DMEK, vision often improves within weeks; after DSAEK, within weeks to months. After PK and DALK, vision improves slowly over many months, and the final result often depends on the stitches and astigmatism; PK stitches usually come out at 12–18 months. Read the guide to corneal transplant types and recovery.

Where Does Dr. Fouad El Sayyad See Patients?

• Sayyad Eye Center, Mohandeseen (main branch, where cataract surgery and corneal transplants are performed): 3A Gameat El Dowal El Arabeya St., Sphinx Square.
• Sayyad Eye Center, New Cairo: Medical Park 2, opposite New Cairo Court.

To book an appointment with Dr. Fouad El Sayyad, call or WhatsApp 01000088168.

Frequently Asked Questions

What is the success rate of a corneal transplant?

According to published evidence, most corneal transplants succeed. Large recent studies of Fuchs dystrophy report that about 75–92% of grafts are still clear at ten years, depending on the technique. Results are best in keratoconus and Fuchs dystrophy.

Does eye redness after a corneal transplant mean rejection?

Not always, but redness with light sensitivity, pain or blurred vision can be a sign of rejection. Contact your surgeon the same day, because early treatment can often reverse it.

What causes a corneal transplant to fail?

The main causes are rejection, gradual loss of the donor endothelial cells, glaucoma, infection and problems with the ocular surface. Many of these can be treated if found early.

How long does a corneal transplant last?

Many grafts stay clear for ten years or more, and some for decades. There is no fixed lifetime, and regular follow-up helps the graft last longer.

Can a corneal transplant be repeated?

Yes. A failed graft can usually be replaced with another transplant, often a DMEK or DSAEK, or a new PK. Repeat grafts have a higher risk of rejection.

Which corneal transplant has the lowest risk of rejection?

According to published studies, DALK, because it keeps the patient’s own inner cell layer, and DMEK, which had the lowest rejection rate among the endothelial and full-thickness techniques in a large ten-year study.

Does the eye colour or shape change after a corneal transplant?

No. The iris, which gives the eye its colour, is not changed. The front of the eye may look slightly different close up, especially with stitches, but the eye does not change shape.

Will I see normally after a corneal transplant?

Many patients gain good vision, but often with glasses or contact lenses, especially after PK or DALK. Other eye conditions can limit the final result.

This article is for general education and does not replace an eye examination. Treatment decisions depend on your own eye assessment.

References

• Wilhelm TI, Gauché L, Böhringer D, et al. Ten-year outcomes after DMEK, DSAEK, and PK: insights on graft survival, endothelial cell density loss, rejection and visual acuity. Sci Rep. 2025;15(1):1249.
• Dryander SE, Volpe-Waizel MD, Trouvain AM, et al. Survival of grafts up to 10 years after Descemet membrane endothelial keratoplasty. Cornea. 2026;45(11):1360–1367.
• Moura-Coelho N, Papa-Vettorazzi R, Reyes A, et al. Ultrathin DSAEK versus DMEK: review of systematic reviews. Eur J Ophthalmol. 2024;34(4):913–923.
• Awad AA, Elettreby AM, Abo Elnaga AA, et al. Penetrating keratoplasty versus deep anterior lamellar keratoplasty for keratoconus: a systematic review and meta-analysis of 27,018 eyes. Semin Ophthalmol. 2025;40(5):364–381.
• Yin J. Advances in corneal graft rejection. Curr Opin Ophthalmol. 2021;32(4):331–337.
• Vasiliauskaite I, Kocaba V, van Dijk K, et al. Long-term outcomes of Descemet membrane endothelial keratoplasty: effect of surgical indication and disease severity. Cornea. 2023;42(10):1229–1239.
• Alió del Barrio JL, Bhogal M, Ang M, et al. Corneal transplantation after failed grafts: options and outcomes. Surv Ophthalmol. 2021;66(1):20–40.