Written by the Mungale Eye Hospital team
Medically reviewed by Dr. Meeta Mungale, MBBS, MS (Ophthalmology), DNB · Fellowship in Cornea & Anterior Segment, L V Prasad Eye Institute, Hyderabad · Gujarat Medical Council Reg. No. G-39262 · Reviewed on 7 October 2026
Published 7 October 2026
Part of our guide: Corneal Transplant Surgery: When It Is Needed, Types, Recovery & Risks
The cornea has several layers. Older transplant surgery replaced the whole cornea. Modern lamellar keratoplasty replaces only the layer that is diseased, which can mean faster recovery and lower rejection risk. Understanding the four main types helps patients follow their surgeon's recommendation.
What Are the Layers of the Cornea?
What Is PK?
Penetrating keratoplasty removes a full-thickness circle of the cornea and replaces it with donor tissue, held with stitches.
What Is DALK?
Deep anterior lamellar keratoplasty replaces the epithelium and stroma down to Descemet's membrane, keeping the patient's healthy endothelium.
What Is DSEK?
Descemet's stripping endothelial keratoplasty replaces the diseased endothelium and Descemet's membrane with a thin donor layer that includes some stroma, inserted through a small incision and held with an air bubble.
What Is DMEK?
Descemet's membrane endothelial keratoplasty transplants only Descemet's membrane and endothelium, without stroma.
How Do They Compare?
| Procedure | Layer replaced | Typical use | Recovery | Rejection risk |
|---|---|---|---|---|
| PK | Full thickness | All layers diseased | Slowest | Highest |
| DALK | Front layers | Keratoconus, front scars | Moderate | Low |
| DSEK | Inner layer with some stroma | Endothelial disease | Faster | Lower |
| DMEK | Thinnest inner layer | Endothelial disease | Fastest | Lowest |
How Does the Surgeon Choose?
The choice depends on which layers are diseased, the health of the rest of the eye, previous surgery, surgeon experience and patient factors. Positioning after DSEK and DMEK, often lying face up, helps the graft attach.
Key Takeaways
Final Thoughts
Matching the transplant type to the diseased layer gives the best chance of clear vision and a durable graft. Dr. Meeta Mungale and the team at Mungale Eye Hospital in Vadodara perform PK, DALK, DSEK and DMEK and help patients understand which suits them.
Frequently Asked Questions
Both replace the inner endothelial layer. DSEK includes a thin layer of donor stroma, while DMEK transplants only Descemet's membrane and endothelium. DMEK often gives faster and better visual recovery and lower rejection risk.
DALK is often preferred for keratoconus because it replaces the front layers while keeping the patient's healthy endothelium, reducing rejection risk. PK may be used if DALK is not possible.
Endothelial transplants such as DMEK or DSEK are commonly used for Fuchs' dystrophy because the disease mainly affects the inner endothelial layer.
PK is needed when all corneal layers are diseased, in deep scars with endothelial damage, perforations or some failed grafts. It remains an important procedure.
DALK usually requires stitches. DSEK and DMEK are performed through small incisions and need few or no stitches, using an air bubble to hold the graft in place.
Sources and further reading
Reviewed by
MBBS, MS (Ophthalmology), DNB · Fellowship in Cornea & Anterior Segment, L V Prasad Eye Institute, Hyderabad
Gujarat Medical Council Reg. No. G-39262
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