Beyond penetrating keratoplasty: the challenge of endothelial transplantation

The paper will present a complete review of the technique of endothelial keratoplasty (EK). History as well as basic principles necessary to understand the mechanisms of EK will be introduced to the attendees. In setting the indication to EK, the author will discuss the role of recipient corneal status, type of endothelial disease, concomitant eye disease (i.e. glaucoma), presence of clear lens and other preoperative factors. The different techniques of Descemet stripping automated endothelial keratoplasty (DSAEK) and Descemet membrane endothelial keratoplasty (DMEK) will be presented, pointing out the single steps, which are instrumental in facilitating surgery, while improving the final outcome. In case of multiple intervention, combined versus sequential procedures (e.g. phacoemulsification, IOL surgery, vitrectomy, etc.) will be discussed. The authors will highlight advantages and disadvantages of different surgical approaches. Possible implications for eye banking will also be addressed, with particular emphasis on preparation and storage of tissue for DSAEK and DMEK. Slides and videos of case studies will illustrate the most common complications (i.e. graft detachment, dislocation, failure, rejection etc.) as well as the appropriate solutions.