A historical view of the development of corneal transplantation: from penetrating keratoplasty to selective transplantation of the finest corneal layers

Replacement of damaged corneal tissue with a clear transplant represents a viable solution for restoring vision in patients with corneal blindness. Among organ transplants, corneal transplantation occupies a unique status due to the cornea's lack of vascularization. This avascular nature makes immune compatibility testing between donor and recipient unnecessary and reduces the risk of transplant rejection, making corneal transplantation the most successful organ transplant procedure worldwide. Over the past century, corneal transplantation has undergone a transformative journey, evolving from full-thickness keratoplasty to highly refined techniques that selectively target individual diseased corneal layers. These modern lamellar approaches aim for faster recovery times and reduced rejection rates. The global demand for corneal graft tissue far exceeds the availability of donor tissue, leading to prolonged waiting times for patients in need of transplantation. Modern therapeutic strategies are expected to support or potentially even replace transplantation of corneal layers in the future.