Descemet stripping and automated endothelial keratoplasty: an alternative to penetrating keratoplasty.
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.
Chih
Andreea
A
William Chappell, Jr. VA Medical Center, Daytona Beach, Florida 32114, USA. chih2005@yahoo.com
Lugo
Miguel
M
Kowing
Dianne
D
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