Corneal Transplantation: Endothelial Keratoplasty/DSAEK

Abstract

The last two decades has heralded a revolutionary shift in the treatment of corneal endothelial disease. Previously, the only surgical treatment for corneal edema due to Fuchs’ dystrophy or pseudophakic bullous keratopathy was a full-thickness penetrating keratoplasty. Although full-thickness corneal transplantation has been widely successful for many decades, it requires months of refractive adjustments before the eyes can achieve visual stability. This evolutionary change has seen the number of endothelial corneal transplants in the United States rise from just over 6000 in 2006 to nearly 31,000 in 2018. Endothelial keratoplasty (EK) enables the surgical treatment of corneal endothelial disease with less extensive surgery, faster visual recovery, less corneal irregularity induced by suturing, a lower risk of rejection, and improved globe stability as compared to traditional penetrating keratoplasty (PK). The EK procedure selectively replaces only the inner layers of the cornea, i.e., the endothelium. Because of these advantages, EK is the preferred operation over PK when only the endothelium of the patient’s cornea is diseased. Each new iteration of endothelial keratoplasty has involved the increasingly selective transplantation of corneal endothelial cells.