title: Descemet stripping and automated endothelial keratoplasty: an alternative to penetrating keratoplasty.
abstract: OBJECTIVE
  To discuss Descemet stripping and automated endothelial keratoplasty (DSAEK) as an alternative to penetrating keratoplasty (PK), and to review the evolution of endothelial keratoplasty (EK) for endothelial dysfunction.
  
  
  METHODS
  The endothelium of the right eye was removed through a 5-mm limbal incision and was replaced with a prepared donor endothelium that included posterior stromal tissue.
  
  
  RESULTS
  After DSAEK, the patient's vision improved more rapidly and remained more stable than is typical for patients undergoing PK.
  
  
  CONCLUSIONS
  DSAEK provides an alternative both to PK and to a repeat PK in patients with failed grafts because of endothelial cell dysfunction. The advantages DSAEK surgery can offer are a quicker visual recovery, a more stable refraction, a tectonically more stable globe, and fewer ocular surface defects associated with corneal sutures or the surface graft host interface. The limitations associated with DSAEK include donor button dislocation and endothelial cell loss and dysfunction. Whether DSAEK or PK offers the best visual outcome and graft survival over the long term is unknown. Caution is advised until multicenter trials confirm the optimal procedure.
authors.affiliation: William Chappell, Jr. VA Medical Center, Daytona Beach, Florida 32114, USA. chih2005@yahoo.com
authors.forename: Andreea
authors.initials: A
authors.lastname: Chih
authors.forename: Miguel
authors.initials: M
authors.lastname: Lugo
authors.forename: Dianne
authors.initials: D
authors.lastname: Kowing
mesh_terms: D016039:Corneal Transplantation; D003695:Delivery of Health Care; D003886:Descemet Membrane / Q000601:surgery*; D004728:Endothelium, Corneal / Q000473:pathology / Q000637:transplantation*; D005260:Female; D006801:Humans; D015948:Keratoplasty, Penetrating; D008875:Middle Aged; D011183:Postoperative Complications; D014019:Tissue Donors; D014792:Visual Acuity