Trends in corneal transplantation. Ultrathin DSAEK – an option of endothelial keratoplasty

Abstract

Introduction: Corneal blindness is the third leading cause of blindness in the world. Each year more than 180,000 corneal transplants are performed worldwide. The most common indications for the procedure are Fuch’s dystrophy, keratoconus, bullous keratopathy and infectious keratitis. Penetrating keratoplasty (PK) used to be the leading approach for a long time until other techniques without any requirements of transplanting all the layers of cornea, had emerged. Descemet Stripping Automated Endothelial Keratoplasty (DSAEK), ultrathin DSAEK and Descemet Membrane Endothelial Keratoplasty (DMEK) are partialthickness endothelial keratoplasties which can be an option for a surgical treatment of corneal endothelial dysfunction without cornea fibrosis. DSAEK or ultrathin DSAEK involves transplanting the endothelium, Descemet‘s membrane and a thin layer of posterior stroma onto the surface of posterior stroma after descemetorhexis. The indications for DSAEK are endothelial dysfunctions (Fuch‘s endothelial dystrophy, bullous keratopathies – especially associated with glaucoma drainage device, aphakia, aniridia, anterior chamber intraocular lens), iridocorneal-endothelial syndrome, late failure of PK, if refractive outcome is acceptable prior to endothelial failure. The first clinical case that shows successful transition to ultrathin DSAEK in endothelial dysfunction is presented below. The case: A 68-year-old woman was diagnosed with pseudophakic bullous keratopathy (cataract phacoemilsification with posterior chamber intraocular lens implantation) three years ago . It was decided to perform partial-thickness keratoplasty because the patient had an endothelial dysfunction that was visually disabling and caused eye pain, but no severe stromal opacity was present. In January 2019 ultrathin DSAEK was performed. Anterior segment optic coherence tomography showed transplant to be fully attached during follow-up pos.[...].