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Evolution of Posterior Lamellar Keratoplasty: PK – DLEK – DSEK/DSAEK – DMEK – DMET

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Current Treatment Options for Fuchs Endothelial Dystrophy

Abstract

The history of corneal transplantation is almost 200 years old. To date, corneal transplantation is the most commonly performed transplantation in medicine.

For a long time, the only treatment to restore corneal transparency in patients with corneal endothelial disease, such as Fuchs endothelial corneal dystrophy (FECD), was by replacing the diseased cell layer by a full-thickness penetrating transplant. Recently, corneal transplantation evolved from unselective full-thickness penetrating keratoplasty (PK) to selective lamellar corneal tissue replacement (Descemet stripping (automated) endothelial keratoplasty (DSEK/DSAEK) and Descemet membrane endothelial keratoplasty (DMEK)) resulting in faster wound healing, preservation of the ocular surface and globe integrity, better clinical outcomes, and reduced complications.

With these fascinating novel keratoplasty techniques, also new insight into corneal endothelial cell biology and physiology ensued. This knowledge has led to further modifications of currently available techniques, such as, e.g., using half-moon-shaped grafts (hemi-DMEK) and “non-keratoplasty” surgical approaches like performing a “descemetorhexis only” or a descemetorhexis with a “free-floating” graft secured in the main incision (Descemet membrane endothelial transfer (DMET)).

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Disclosure

Drs Melles, Baydoun, and Dapena are consultants for DORC International/Dutch Ophthalmic, USA; Dr. Melles is a consultant for SurgiCube International.

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Authors and Affiliations

  1. Netherlands Institute for Innovative Ocular Surgery, Rotterdam, The Netherlands

    Lamis Baydoun, Isabel Dapena & Gerrit Melles MD, PhD

  2. Melles Cornea Clinic Rotterdam, Rotterdam, The Netherlands

    Lamis Baydoun, Isabel Dapena & Gerrit Melles MD, PhD

Authors
  1. Lamis Baydoun
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  2. Isabel Dapena
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  3. Gerrit Melles MD, PhD
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Correspondence to Gerrit Melles MD, PhD .

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Editors and Affiliations

  1. Department of Ophthalmology, University of Cologne, Cologne, Germany

    Claus Cursiefen

  2. Wilmer Eye Institute, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA

    Albert S. Jun

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Baydoun, L., Dapena, I., Melles, G. (2017). Evolution of Posterior Lamellar Keratoplasty: PK – DLEK – DSEK/DSAEK – DMEK – DMET. In: Cursiefen, C., Jun, A. (eds) Current Treatment Options for Fuchs Endothelial Dystrophy. Springer, Cham. https://doi.org/10.1007/978-3-319-43021-8_5

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  • DOI: https://doi.org/10.1007/978-3-319-43021-8_5

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