Surgical strategies to improve visual outcomes in corneal transplantation

Abstract

The recent years have brought about a sea change in the field of corneal transplantation with penetrating keratoplasty being phased to newer lamellar keratoplasty techniques for a variety of corneal pathology. Improved and innovative surgical techniques have allowed selective replacement of diseased host corneal layers with pre-prepared healthy donor corneal lamellae for anterior corneal disorders such as keratoconus and posterior corneal disorders such as Fuch's corneal endothelial dystrophy. The results of lamellar techniques are encouraging, with rapid visual rehabilitation and vastly reduced risk of immune-mediated transplant rejection. The techniques of deep anterior lamellar keratoplasty and Descemet's stripping endothelial keratoplasty (DSAEK) continue to evolve with advent of femtosecond lasers and newer concepts such as pre-conditioned donor corneas for Microthin DSAEK and Descemet's membrane keratoplasty. This review describes the current developments in lamellar keratoplasty, including the futuristic approach using cell therapy to restore vision in corneal blindness.

Silk Fibroin Films for Corneal Endothelial Regeneration: Transplant in a Rabbit Descemet Membrane Endothelial Keratoplasty

“…2 However, this procedure is limited by the shortage of highquality donor corneas. 10 Due to recent advances in the field of biomaterials and the culture of CECs, the development of artificial endothelial grafts could be an alternative to traditional surgeries.…”

“…Moreover, these types of surgeries are minimally invasive compared with the current PK technique, in which the anterior chamber is exposed to the environment, avoiding the risk of ocular surface complications, [3][4][5] suture-related infections, 6,7 and devastating expulsive haemorrhage intraoperatively or postoperatively. 8,9 Despite that DMEK surgery is more complex in graft preparation and handling than other posterior lamellar keratoplasties, 10 it is the most in-demand surgical technique because it does not have the disadvantages of transferring another cell type and offers faster and more complete visual rehabilitation than DSAEK. [11][12][13][14][15][16][17] However, as in other surgical techniques, it still requires of human donors.…”

Effect of vital dyes on human corneal endothelium and elasticity of Descemet’s membrane

“…The introduction of posterior lamellar keratoplasty—i.e. the selective transplantation of specific lamellar corneal tissue layers—by Melles et al in 1998 [ 2 – 5 ] ( Fig 1A ) revolutionised the field and significantly improved postoperative visual acuity results. Since then, this technique has undergone further refinements, culminating in the two currently most commonly performed procedures (a) Descemet stripping automated endothelial keratoplasty (DSAEK), and (b) Descemet membrane endothelial keratoplasty (DMEK) [ 6 – 9 ].…”

Visual Outcomes and Graft Thickness in Microthin DSAEK—One-Year Results

“…13,14 We recently reported a technique to prepare thin DSAEK grafts by controlling donor thickness using pachymetry-controlled stromal dehydration before microkeratome dissection (microthin DSAEK). 13,15 The purpose of this study was to assess visual outcomes, graft thickness, rate of graft detachment, primary failure, immune rejection, and endothelial cell loss in the first cohort of patients undergoing microthin DSAEK surgery with 12-month follow-up.…”