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Posterior lamellar keratoplasty: techniques, outcomes, and recent advances
Elizabeth Yeu1, José A P Gomes, Brandon D Ayres
1From the Eastern Virginia Medical School and Virgina Eye Consultants, Norfolk, Virginia (Yeu); Department of Ophthalmology, UNIFESP/EPM and Instituto Suel Abujamra, Sao Paulo, Brazil (Gomes); Wills Eye Hospital, Philadelphia, Pennsylvania (Ayres); University of Toronto, Ontario, and the Eye Bank of Canada, Ontario Division, Ontario, Canada (Chan); Duke Eye Center, Durham, North Carolina (Gupta); Comprehensive Eyecare of Central Ohio, Westerville (Beckman); Department of Ophthalmology, Ohio State University, Columbus (Beckman); Gavin Herbert Eye Institute, University of California, Irvine (Farid); Department of Ophthalmology, University of Cincinnati, and Cincinnati Eye Institute, Cincinnati, Ohio (Holland); Duke Eye Center and Duke University School of Medicine, Durham, North Carolina (Kim); Weill Cornell Medicine and New York Presbyterian Hospital, New York, New York (Starr); Scripps Clinic Medical Group, La Jolla, California (Mah).
Abstract:
Over the past 2 decades, posterior lamellar keratoplasty (PLK) has emerged as an alternative to penetrating keratoplasty in the treatment of corneal endothelial disorders. The reasons for this trend include the search for a safer procedure to replace diseased endothelium that provides faster and better visual rehabilitation and reduces the need for postoperative care. Different surgical techniques, surgical instruments, devices, and lasers have been introduced to overcome technical difficulties, thus improving clinical outcomes. Yet, surgeons and eye banks must address the complications and limitations that arise during the transition to these new techniques. This review discusses the most significant aspects of the evolution of PLK, including a detailed description of current techniques and the direction of future treatment for corneal endothelial disease with the use of laser-assisted surgery, bioengineered corneas, cell therapy, and new pharmacologic therapy.
