Endothelial keratoplasty: is Descemet membrane endothelial keratoplasty the Holy Grail of lamellar surgery? No

Abstract

Posterior lamellar surgery has transformed the management of corneal endothelial disease due to faster visual rehabilitation, minimal refractive change, and maintenance of the ocular structural integrity compared full thickness keratoplasty. Although Descemet’s membrane endothelial keratoplasty (DMEK) appears to offer an anatomical repair for endothelial pathology, replacing only endothelium and Descemet’s membrane without any posterior stroma,1 it has yet to supersede Descemet’s stripping endothelial keratoplasty (DSEK) and its variations; ultrathin Descemet’s stripping automated endothelial keratoplasty (UT-DSAEK),2,3 thin manual Descemet stripping keratoplasty (TMDSEK),4 and pre-Descemet’s endothelial keratoplasty (PDEK)5 as the mainstay the treatment of Fuchs endothelial dystrophy or bullous keratopathy. The main reason for this is that DMEK is technically more challenging, requiring prolonged surgical time, associated with a steeper learning curve and possibly more potential complications.6,7

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Identifiers

ORCID for Parwez Hossain: orcid.org/0000-0002-3131-2395

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