keratoplasty is a surgical procedure involving the replacement, reshaping, or repair of corneal tissue, most commonly performed as a corneal transplant using donor tissue (allograft) to restore vision, relieve pain, or treat structural compromise of the cornea. It differs from keratectomy, which involves removal of corneal tissue without graft replacement, and from keratotomy, which refers to an incisional procedure on the cornea without tissue replacement. The procedure addresses pathology at the cellular and structural level, replacing opacified, scarred, edematous, or ectatic corneal stroma and/or endothelium with healthy donor tissue to restore corneal clarity and curvature. Keratoplasty is exclusively a therapeutic/surgical intervention — there is no physiological form, as the cornea does not naturally regenerate full-thickness tissue. The major clinically relevant subtypes encountered in coding include penetrating keratoplasty (full-thickness graft), performed for conditions such as keratoconus (H18.601-H18.609) or corneal scarring (H17.x); and endothelial keratoplasty (posterior lamellar graft, e.g., DSEK/DMEK), performed primarily for endothelial dysfunction such as Fuchs’ endothelial dystrophy (H18.51x). Keratoplasty is frequently confused with keratoprosthesis, which involves implantation of an artificial corneal device rather than donor tissue, and with keratectomy, which removes tissue without grafting.
Greek κέρας (kéras), combining form κερατο- (kerato-) (keh-rah-TOH)
“horn,” “horny tissue” — anatomical/structural prefix referring to the cornea (named for its horn-like translucent appearance) or to keratin-containing tissue
Greek πλάσσειν (plássein) (PLAS-seyn), from πλαστός (plastós) (plahs-TOS)
“to mold,” “to form,” “molded, shaped” — noun-forming suffix denoting a surgical procedure to form, repair, or restore a body part
The word entered English in the mid-19th century as keratoplasty (noun), formed directly from the Greek combining form kerato- (“cornea/horn”) and the surgical suffix -plasty (“molding/surgical repair”), a pattern borrowed from earlier German medical literature (Keratoplastik). The root kerato- connects KERATOPLASTY to the entire -kerat- root family: keratitis (corneal inflammation), keratoconus (cone-shaped cornea), and keratometry (measurement of corneal curvature). The suffix -plasty is highly productive in surgical terminology and is is also seen in rhinoplasty, blepharoplasty, tympanoplasty, arthroplasty, and otoplasty.
🔀 ALIASES / ALTERNATE TERMS
Keratoplastic(adjective form — e.g., “keratoplastic graft,” “keratoplastic technique,” “post-keratoplastic astigmatism”)
Corneal transplant / corneal grafting(lay and clinical term; most commonly used in patient-facing documentation and op notes)
Penetrating keratoplasty (PK/PKP)(full-thickness corneal transplant; replaces entire corneal thickness including epithelium, stroma, and endothelium)
Lamellar keratoplasty(partial-thickness corneal transplant; replaces only the anterior or posterior layers of the cornea, sparing healthy host tissue)
H18.601|Endothelial corneal dystrophy, right eye(common indication for endothelial keratoplasty; bilateral and unspecified codes also exist)
DMEK(Descemet membrane endothelial keratoplasty — thinner posterior lamellar graft using only Descemet’s membrane and endothelium)
Therapeutic keratoplasty(performed primarily to treat active infection or perforation rather than to restore vision)
Optical keratoplasty(performed primarily to restore visual acuity by replacing opacified corneal tissue)
Tectonic keratoplasty(performed to restore structural integrity of the globe, e.g., after perforation or severe thinning; often coded with H16.041|Corneal perforation, right eye)
Regraft / repeat keratoplasty(repeat transplant following graft failure or rejection; coded with T86.840|Corneal transplant rejection)
Limbal keratoplasty(graft involving the limbus, the junction between cornea and sclera; less common, used in select reconstructive cases)
🔗 RELATED TERMS
Keratectomy — surgical removal of corneal tissue without replacement; differs from keratoplasty in that no donor graft is placed, as seen in photorefractive keratectomy (PRK) for refractive correction.
Keratotomy — incisional procedure on the cornea (e.g., radial keratotomy); shares the kerat- root but involves cutting rather than tissue replacement.
T86.840|Corneal transplant rejection — an immune-mediated complication of keratoplasty in which the host immune system attacks the donor graft; distinguished from graft failure due to mechanical or technical causes.
T86.841|Corneal transplant failure — non-immune loss of graft function or clarity following keratoplasty, often due to endothelial decompensation; frequently overlaps with rejection in documentation and requires careful query for distinction.
Corneal endothelium — the innermost single-cell layer of the cornea responsible for maintaining corneal deturgescence (fluid balance); its dysfunction is the primary target of endothelial keratoplasty.
Graft rejection — the immunologic mechanism by which donor corneal tissue is attacked by host T-cells; presents with the classic findings of redness, sensitivity to light, decreased vision, and pain.
H18.10|Bullous keratopathy, unspecified eye]] — a common indication for keratoplasty resulting from chronic corneal edema and endothelial failure, often following intraocular surgery (pseudophakic/aphakic bullous keratopathy).
H18.601|Keratoconus, unspecified, right eye — progressive corneal ectasia and one of the most common indications for penetrating keratoplasty in younger patients.
H18.51x|Fuchs’ endothelial dystrophy — the most common indication for endothelial keratoplasty (DSEK/DMEK), characterized by progressive endothelial cell loss and corneal edema.
Z94.7|Corneal transplant status — status code indicating the patient has a history of corneal transplant, frequently reported on follow-up encounters.
Specular microscopy — diagnostic procedure used to evaluate corneal endothelial cell density and morphology, critical for both pre-transplant donor tissue assessment and post-transplant graft monitoring.
Ocular surface reconstruction; limbal conjunctival autograft (e.g., for recurrent pterygium)
⚠️ Coding Note: Laterality is mandatory for nearly all ophthalmic ICD-10-CM codes paired with keratoplasty (H16.x, H17.x, H18.x), so the operative report and history & physical must be reviewed for right, left, or bilateral specificity before code assignment — query the provider if laterality is absent or conflicting between documents. Sequencing logic: the underlying corneal pathology (e.g., keratoconus, bullous keratopathy, corneal scar) is coded first as the principal diagnosis driving the surgical encounter, with Z94.7 used only on subsequent encounters to indicate transplant status, not as a reason for the current admission. A frequently undercoded scenario on inpatient profee claims is failure to capture T86.840 or T86.841 when documentation mentions “graft failure,” “cloudy graft,” or “rejection episode” — these terms should trigger a query if not explicitly linked to a T86.84x code. For CPT selection, distinguish carefully between 65730 (standard penetrating keratoplasty), 65750/65755 (aphakic/pseudophakic penetrating keratoplasty — payer-specific documentation of lens status is required), and 65756 (endothelial keratoplasty, e.g., DSEK/DMEK) — selecting the wrong CPT based on lens status is a common audit finding for Medicare and BCBS of WI claims. Repeat keratoplasty (regraft) for graft failure should be coded with the same CPT as the original procedure type, with the T86.84x complication code sequenced to support medical necessity.