title: Endokeratoplasty as an alternative to penetrating keratoplasty for the surgical treatment of diseased endothelium: initial results.
abstract: OBJECTIVE
  To test the feasibility of a new surgical technique aimed at replacing diseased corneal endothelium while minimizing visual recovery time.
  
  
  METHODS
  Noncomparative, prospective, clinic-based, interventional case series.
  
  
  METHODS
  A total of seven patients with aphakic bullous keratopathy (n = 2), pseudophakic bullous keratopathy (n = 4), or Fuchs' corneal dystrophy (n = 1) participated.
  
  
  METHODS
  All patients underwent a surgical procedure including removal of the epithelium, creation of a 9.5-mm corneal flap, substitution of an underlying 6.5-mm button of deep stroma and endothelium with a 7.0-mm donor button, and suturing of the flap back into position using a 10-0 running nylon suture. In the two most recently operated patients, anterior lamella, 160 microm in thickness, was removed from the donor button before transplantation.
  
  
  METHODS
  Visual acuity, refraction, keratometry, corneal topography.
  
  
  RESULTS
  All corneas were clear, and the surface reepithelialized within 4 weeks after surgery. Regular astigmatism of less than 4 diopters was recorded in all cases as early as 4 weeks after surgery. Epithelial interface ingrowth with extensive melting of the corneal flap was observed in one patient 3 months after surgery and was managed by removal of the flap and resuturing of the donor button.
  
  
  CONCLUSIONS
  Endokeratoplasty represents a promising alternative to conventional penetrating keratoplasty for patients with diseased corneal endothelium.
authors.affiliation: University of Ferrara, Department of Ophthalmology, Ferrara, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Busin
authors.forename: R C
authors.initials: RC
authors.lastname: Arffa
authors.forename: A
authors.initials: A
authors.lastname: Sebastiani
mesh_terms: D000368:Aged; D003316:Corneal Diseases / Q000473:pathology / Q000601:surgery*; D019781:Corneal Topography; D016039:Corneal Transplantation / Q000379:methods*; D004728:Endothelium, Corneal / Q000473:pathology / Q000601:surgery*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D015948:Keratoplasty, Penetrating; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012029:Refraction, Ocular; D013524:Surgical Flaps; D013536:Suture Techniques; D016896:Treatment Outcome; D014792:Visual Acuity