Advances in endothelial keratoplasty

Birbal, R.S.

Corneal diseases are among the leading causes of reversible blindness worldwide. When conservative treatment options fail, many eyes can be treated with corneal transplantation. Historically, full thickness corneal transplantation, in which all corneal layers are replaced, has been the mainstay of care in the treatment of corneal endothelial disorders. In the past two decades, however, there has been a trend towards the selective, less invasive replacement of only the diseased, rather than all corneal layers. These partial thickness corneal transplantations are known as lamellar keratoplasties. Lamellar keratoplasty has significantly improved the clinical outcomes, such as visual acuity, after transplantation. Since its introduction in 1998, lamellar keratoplasty has evolved from Deep lamellar endothelial keratoplasty to Descemet membrane endothelial keratoplasty (DMEK). Globally, however, there is only one donor cornea available for 70 people in need. This shortage inspired...Show moreCorneal diseases are among the leading causes of reversible blindness worldwide. When conservative treatment options fail, many eyes can be treated with corneal transplantation. Historically, full thickness corneal transplantation, in which all corneal layers are replaced, has been the mainstay of care in the treatment of corneal endothelial disorders. In the past two decades, however, there has been a trend towards the selective, less invasive replacement of only the diseased, rather than all corneal layers. These partial thickness corneal transplantations are known as lamellar keratoplasties. Lamellar keratoplasty has significantly improved the clinical outcomes, such as visual acuity, after transplantation. Since its introduction in 1998, lamellar keratoplasty has evolved from Deep lamellar endothelial keratoplasty to Descemet membrane endothelial keratoplasty (DMEK). Globally, however, there is only one donor cornea available for 70 people in need. This shortage inspired further refinement of conventional DMEK and led to the development of adapted DMEK-techniques, which may increase the availability of endothelial donor grafts. This thesis focuses on donor tissue preparation for DMEK and evaluates the feasibility and clinical outcomes of DMEK, DMET, Hemi-DMEK and Quarter-DMEK in the management of corneal endothelial disorders.
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Advances in endothelial keratoplasty

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