ADVANCES IN CORNEAL TRANSPLANTATION, TECHNIQUES SURGICAL IMPROVEMENT, CLINICAL OUTCOMES AND FUTURE PROSPECTS

Abstract

Corneal transplantation remains the definitive treatment for restoring vision in patients with irreversible corneal diseases, including keratoconus, Fuchs endothelial corneal dystrophy, infectious keratitis, and corneal scarring. Over the past two decades, substantial advances in surgical techniques, donor tissue preparation, and regenerative technologies have transformed keratoplasty from conventional full-thickness procedures to selective lamellar approaches with superior clinical outcomes. This review critically synthesizes recent evidence on advances in corneal transplantation, focusing on modern surgical techniques, technological innovations, clinical outcomes, and future prospects. A systematic literature review was conducted using peer-reviewed publications indexed in major scientific databases between 2019 and 2025. Eighty eligible studies were analyzed through descriptive and thematic synthesis. The findings demonstrate that Deep Anterior Lamellar Keratoplasty (DALK), Descemet Stripping Automated Endothelial Keratoplasty (DSAEK), and particularly Descemet Membrane Endothelial Keratoplasty (DMEK) provide faster visual rehabilitation, improved graft survival, lower endothelial cell loss, and reduced graft rejection compared with penetrating keratoplasty. Advances in femtosecond laser-assisted surgery, intraoperative optical coherence tomography, improved donor tissue preservation, and eye banking have further enhanced surgical precision and postoperative outcomes. Emerging technologies, including artificial intelligence, stem cell therapy, tissue engineering, and bioengineered corneas, show considerable potential to address donor tissue shortages and improve long-term transplantation success. Despite these advances, challenges related to surgical complexity, donor availability, healthcare accessibility, and long-term graft survival remain. The review concludes that integrating innovative surgical techniques with regenerative medicine and artificial intelligence is likely to redefine the future of corneal transplantation by improving patient outcomes, expanding treatment accessibility, and reducing the global burden of corneal blindness.