Endothelial Keratoplasty: From DLEK to DMEK

Abstract

The last decade has heralded a revolutionary shift in the treatment of corneal endothelial disease. Only 15 years ago, the only surgical treatment for pseudophakic bullous keratopathy and Fuchs dystrophy was penetrating keratoplasty (PK). Although used successfully for over a century, PK requires many months of refractive adjustments before the eye achieves visual stability. Starting with the advent of posterior lamellar keratoplasty in the late 1990s, a number of procedures have been developed, refined, and widely adopted, which have given patients faster recoveries and improved globe stability in comparison to traditional corneal transplantation. Each iteration of endothelial keratoplasty (EK) has involved the increasingly selective transplantation of corneal endothelial cells. Preliminary results of the most recent form of EK, Descemet's membrane EK, suggest that pure endothelial cell transplantation is on the horizon.

Keywords: DSEK; Deep Lamellar Endothelial Keratoplasty; Descemet Stripping and Automated Endothelial Keratoplasty; Descemet's Membrane Endothelial Keratoplasty; Endothelial Keratoplasty.

Figure 1

(A) In deep lamellar endothelial keratoplasty, Descemet's membrane and posterior corneal stroma is removed. It is replaced by a graft consisting of posterior stroma and Descemet's membrane; (B) In Descemet's stripping automated endothelial keratoplasty, only the host Descemet's membrane is removed. This is replaced by a donor graft of posterior stroma and Descemet's membrane; (C) In Descemet's membrane endothelial keratoplasty, only the host Descemet's membrane is removed and replaced with the donor Descemet's membrane. Corneal stroma is not transplanted.