Evolving indications for Descemet's stripping automated endothelial keratoplasty

Recent advances in the field of endothelial transplantation, including increasing acceptance of Descemet's membrane endothelial keratoplasty, may alter the indications for Descemet's stripping automated endothelial keratoplasty, to a procedure reserved for complex endothelial disorders.

Recent literature demonstrates that Descemet's membrane endothelial keratoplasty provides better and faster visual outcomes and decreased immunologic rejection compared to Descemet's stripping automated endothelial keratoplasty. However, Descemet's membrane endothelial keratoplasty may be more challenging in the management of a number of more complex endothelial disorders. While the literature on complex Descemet's membrane endothelial keratoplasty is limited, the utility of Descemet's stripping automated endothelial keratoplasty has been validated in the management of endothelial dysfunction in the setting of a number of comorbid conditions including prior penetrating keratoplasty, prior glaucoma surgery, iridocorneal endothelial syndrome, aniridia, aphakia, and anterior chamber intraocular lenses, among others.

The increasing adoption of Descemet's membrane endothelial keratoplast is changing the practice of endothelial keratoplasty. However, limitations of the Descemet's membrane endothelial keratoplasty procedure have also served to crystallize the essential role of Descemet's stripping automated endothelial keratoplasty in many complex endothelial keratoplasty scenarios. This article will review indications for endothelial keratoplasty, along with the current evidence for Descemet's stripping automated endothelial keratoplasty and Descemet's membrane endothelial keratoplasty in their management.