Remarkably, corneal transplantation is considered one of the most successful of all transplanted organs. There are a number of factors contributing to this. We used to think that it was protected from immune recognition due to the lack of blood vessels. More recently, we have a better understanding that the eye along with the CSF (cerebral spinal fluid) and blood stream constitute the 3 most rapid methods of antigen or “foreign” matter detection and we have revised our thinking with respect to Corneal Transplantation as a precess of antigen “tolerance” rather than lack of recognition. There are certain things that can throw this “out of whack” and other high risk states that involve previous corneal transplantation rejection, corneal neovascularization, large or peripheral grafts, and additional factors that include poor corneal sensation, medication compliance, and internal scar tissue. Today’s video involves an extremely happy patient who has visited several major eye facilities including Baltimore and is considered high risk from previous tumor radiation, poor corneal sensation, and neovasularization. It is not my prettiest surgery but if you skip to the end you can see a nice result and a very happy patient who was reading our Snellen Acuity Chart the next day which he could not do before surgery. Enjoy!