Endothelial keratoplasty - a review

Area of Science:

• Ophthalmology
• Transplantation Surgery
• Corneal Disease

Background:

• Penetrating keratoplasty (PK) was historically the primary corneal transplant, but has limitations.
• Endothelial keratoplasty (EK) evolved to address PK's drawbacks, focusing on posterior corneal layers.
• Recent advancements have made EK the preferred method for endothelial dysfunction.

Purpose of the Study:

• To review the evolution and current state of endothelial keratoplasty.
• To compare EK with penetrating keratoplasty regarding outcomes and complications.
• To detail Descemet stripping automated EK techniques and patient selection.

Main Methods:

• Review of historical and current techniques in endothelial keratoplasty.
• Comparison of visual recovery, refractive outcomes, and endothelial cell loss between EK and PK.
• Discussion of candidate selection, surgical methods, and postoperative management for EK.

Main Results:

• EK provides faster visual rehabilitation and less induced astigmatism compared to PK.
• EK enhances globe integrity, reducing risks of wound rupture.
• Descemet stripping automated EK is the most prevalent technique.

Conclusions:

• Endothelial keratoplasty represents a significant advancement over penetrating keratoplasty for endothelial dysfunction.
• EK offers superior visual and safety outcomes, with Descemet stripping automated EK being the standard.
• Understanding EK techniques, candidacy, and potential complications is crucial for optimal patient care.