Can CAIRS Save You From a Full Thickness Corneal Transplant?

For decades, people with advancing keratoconus were given a daunting road map: glasses, then contact lenses, and when those failed, a corneal transplant. If you’ve been told a transplant may be in your future, this post is for you, because for many patients CAIRS now offers a different path.

And here is the part I find patients are most surprised by: CAIRS is itself a type of corneal transplant. CAIRS stands for Corneal Allogenic Intrastromal Ring Segments — crescent-shaped segments made from donor corneal tissue, which makes the procedure, strictly speaking, a form of keratoplasty. Both operations use donor tissue. What separates them is what happens to your own cornea, and that is why the recovery and the risks look so different.

Two transplants, two completely different operations

In a full-thickness corneal transplant (penetrating keratoplasty, or PK), the central portion of your cornea is removed entirely and replaced with a donor cornea, held in place with many fine sutures. It is a superb operation when it’s truly needed — I perform them regularly — but it is a big undertaking: vision takes a year or more to settle, sutures need managing, rejection is a lifelong consideration, and the eye never regains its original structural strength.

CAIRS works the other way around. Instead of removing your cornea, I use a femtosecond laser to create a precise, small tunnel within it, and slide the donor tissue segments inside. Every layer of your own cornea stays exactly where it is. The segments reshape the cone from within, flattening and regularising the cornea so that glasses and contact lenses work better, and for suitable patients that can mean a full-thickness graft is never needed at all.

If you’d like to see how it all works without any surgical footage, this short animation walks through the entire procedure:

	CAIRS	Full-thickness transplant (PK)
Your own cornea	Fully preserved	Central cornea removed
Sutures	Usually none	Many, managed over 12+ months
Visual recovery	Improvement within days to weeks; vision settles over the following weeks	Commonly a year or more
Rejection risk	Very rare	Lifelong consideration
Reversible or adjustable	Yes — segments can be exchanged or removed	No
Future options	All preserved, including transplant	Repeat grafts become more complex

Because the segments I implant are processed, sterilised corneal tissue placed within the layers of your own cornea, rejection is very rare. That is a stark contrast to a full-thickness graft, where rejection episodes remain a lifelong possibility. And because nothing is removed, CAIRS keeps every future option open: it can be combined with corneal cross-linking to stabilise the cornea against further progression, adjusted or reversed if your needs change, and it does not prevent a transplant later in the unlikely event one is ever required.

So, can CAIRS save you from a full-thickness transplant?

For many patients, yes. The patients who benefit most are those with keratoconus that has progressed beyond what glasses or contact lenses can comfortably manage, but whose corneas are still clear. In published series and in my own practice, reshaping the cornea with CAIRS, usually combined with cross-linking, can restore useful spectacle or contact lens vision and take a transplant off the table.

CAIRS cannot help everyone. Dense central scarring, corneas too thin or steep for safe tunnel creation, or the aftermath of corneal hydrops (a sudden, painful swelling of the cornea that can leave a scar) may still point towards a graft, most often a modern lamellar or full-thickness transplant chosen to suit the eye. Working out which group you fall into takes detailed corneal imaging, which is what a CAIRS assessment provides.

Where this is heading

CAIRS was pioneered by Dr Soosan Jacob in India, and I was among the first surgeons in Australia to adopt it. It is now performed in a growing number of countries, and I’ve been fortunate to help train surgeons around the world and co-develop the planning platform cairsplan.com, used by CAIRS surgeons globally. In Australia, Medicare now formally recognises CAIRS as a keratoplasty under item 42653, following a campaign I led, so it is funded accordingly.

Patients regularly travel to Brisbane from interstate and overseas for assessment. If you’re weighing up CAIRS against a transplant, you can read about what recovery looks like week by week and how long CAIRS results last.

This short video explains how to prepare for a CAIRS assessment with me:

Told you’ll need a transplant? Get a second look first

If keratoconus has you facing the prospect of a corneal graft, it is worth finding out whether CAIRS could change that conversation. A thorough assessment will give you an honest answer about which path is right for your eye.