Pre-Descemet's endothelial keratoplasty (PDEK)

Abstract

A new surgical technique for endothelial keratoplasty is described, in which the composite of pre-Descemet's layer (Dua's layer) with Descemet's membrane and endothelium is transplanted subsequent to the removal of the recipient's Descemet's membrane. The technique was performed in five eyes of five patients, with successful attachment of the graft and good postoperative visual recovery in all cases. Postoperative optical coherence tomography showed good graft attachment without interface abnormalities and a mean graft thickness was 28±5.6 μm. This study demonstrates the practicality of the technique, termed pre-Descemet's endothelial keratoplasty (PDEK), which can be a viable option in endothelial keratoplasty with some potential advantages.

Glued Intrascleral Fixation of Intraocular Lens With Pupilloplasty and Pre-Descemet Endothelial Keratoplasty

“…[19][20][21][22][23][24] In our series, a type-1 bubble was formed in all the cases, and no loss of tissue during the process of creation of bubble was reported both with the adult and infant donor cornea. 6,8,9 During the combined procedure, no difficulty was encountered in unfolding the PDEK graft because the addition of the PDL layer to the Descemet membrane (DM)-endothelium complex provides it with an extra splinting effect. In this study, infant donor cornea was used in 2 cases, and problems pertaining to either donor tissue preparation or injection of the donor graft were not encountered during the combined surgical procedure.…”

“…Donor graft preparation has been described before 6 and is summarized here in brief. A type-1 bubble 6,8,9 was created with air injection (Fig.…”

“…A type-1 bubble 6,8,9 was created with air injection (Fig. 1B), and the graft was prepared and stored in McCarey-Kaufman tissue culture medium.…”

“…[2][3][4][5] PreDescemet endothelial keratoplasty (PDEK) is a technique that offers true component replacement of endothelial cells with the splinting effect of the pre-Descemet layer (PDL). 6 Corneal decompensation beginning many years after cataract extraction may be because of excessive loss of endothelium at the time of surgery, followed by ongoing normal or accelerated attrition of the remaining endothelium. The cases incorporated in our current study were postoperative disasters that had been traumatized by previous surgery.…”

The power of observation

“…It has made the procedure safer. In the year since publication of the first paper it has been shown that at the corneal periphery, DL collagen extends as the core of the trabecular meshwork (18) ; that DL together with DM and endothelium can be harvested to perform endothelial keratoplasty (PDEK) with certain advantages (19) and that phacoemulsification with lens implant can be carried out under the exposed layer in the procedure termed DALK-Triple (20) . It has led to further understanding of the microanatomy of the peripheral cornea where we have demonstrated the presence of holes in the layer through which air can escape during BB DALK to access the plane between DL and DM to separate DM without DL (21) .…”