Guest: Professor Mark Daniell, Head of Corneal Research, Centre for Eye Research Australia

In this episode, we unpack what a corneal transplant actually involves, why rejections happen, and how modern “layered” (lamellar) techniques like DSAEK/DMEK are changing recovery and outcomes.

Mark also lifts the curtain on tissue-engineered corneas—how expanding a single donor could help treat more people worldwide—and a new hydrogel scaffold that aims to make delicate endothelial surgery faster, safer, and easier to perform in more places.

In this episode:

• Why corneas fail: common reasons include keratoconus and endothelial failure (e.g., Fuchs dystrophy), where the inner cell layer can’t keep the cornea clear.
• From “open-sky” to layers: Full-thickness grafts (penetrating keratoplasty) once dominated, but today many patients get lamellar transplants—replacing only the diseased layer—improving vision quality and lowering rejection risk.
• Endothelial techniques:
• DSAEK/“DSEK” adds a thin stromal slice + endothelium.
• DMEK transplants just Descemet’s membrane + endothelium for the sharpest optics and the lowest rejection rates.
• Why rejections dropped: Fewer stromal immune cells (like dendritic cells) in lamellar grafts mean fewer immune alarms.
• Tech & tools matter: Microscopy, ultra-fine sutures, and air-bubble “sticking” steps are critical. Mini-scleral contact lenses also help post-graft vision.
• Global need: Millions need corneal surgery, but many regions lack eye banks and surgeons. Expanding endothelial cells from one donor into many grafts could be a game-changer.
• What’s next:
• A dissolving hydrogel scaffold that “pops open” like a tent to simplify DMEK-style surgery.
• Trials exploring cell-only injections of lab-grown endothelium.
• Longer-term efforts to bioprint stroma and generate cells from iPSCs (reprogrammed skin cells).

Key resources for this episode:

Centre for Eye Research Australia: Corneal Transplants: What you need to know 

Keratoconus Australia: Corneal Transplantation 

Acknowledgements

Produced with support from Humdinger Studio (Melbourne), Gulwa Recording Studio (Darwin), the University of Melbourne, the Centre for Eye Research Australia, Optometry Australia, and mivision.

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