Evolution of endothelial keratoplasty.

Area of Science:

• Ophthalmology
• Corneal Surgery
• Transplantation Immunology

Background:

• Endothelial keratoplasty is a preferred alternative to penetrating keratoplasty (PK) for endothelial dysfunction.
• Descemet stripping endothelial keratoplasty (DSEK) is widely accepted, improving upon PK by reducing ocular surface and structural complications.
• Descemet membrane endothelial keratoplasty (DMEK) represents a further advancement, offering enhanced visual recovery and reduced rejection rates.

Purpose of the Study:

• To compare the efficacy and outcomes of Descemet membrane endothelial keratoplasty (DMEK) with Descemet stripping endothelial keratoplasty (DSEK) and penetrating keratoplasty (PK).
• To highlight the advantages of DMEK in addressing remaining challenges in endothelial dysfunction treatment.

Main Methods:

• Review of existing studies comparing different endothelial keratoplasty techniques.
• Analysis of visual recovery, graft rejection rates, and other complications associated with PK, DSEK, and DMEK.

Main Results:

• DMEK demonstrates faster visual recovery compared to DSEK.
• DMEK significantly reduces the risk of immunologic graft rejection episodes versus DSEK and PK.
• DMEK mitigates immunologic graft reactions and secondary glaucoma, key limitations of PK.

Conclusions:

• DMEK offers superior visual outcomes and immunological safety compared to DSEK and PK for treating endothelial dysfunction.
• Advancements in instrumentation and surgical techniques are improving the feasibility and reliability of DMEK procedures.