Lamellar Keratoplasty Techniques

Overview

Journal Indian J Ophthalmol

Specialty Ophthalmology

Date 2018 Aug 22

PMID 30127133

Citations 13

Authors

Nadisha P Singh

Dalia G Said

Harminder Singh Dua

Affiliations

Soon will be listed here.

Abstract

Lamellar keratoplasty (LK) has revolutionized corneal graft surgery in several ways. Deep anterior LK (DALK) has eliminated risk of failure due to endothelial rejection. Endothelial keratoplasty (EK) has almost eliminated induced astigmatism and the "weak" graft-host junction as seen with penetrating keratoplasty (PK) and also reduced the risk of endothelial rejection. LK provided new insights into posterior corneal anatomy that led to better understanding and performance of DALK and to the development of another EK procedure, namely pre-Descemet's EK (PDEK). Surgical procedures for LK were further refined based on the improved understanding and are able to deliver better surgical outcomes in terms of structural integrity and long-term patient satisfaction, reducing the need of further surgeries and minimizing patient discomfort. In most specialist centers, anterior lamellar techniques like DALK and EK techniques like Descemet's stripping EK (DSEK) and Descemet's membrane EK (DMEK) have replaced the full-thickness PK where possible. The introduction of microkeratome, femtosecond laser, and PDEK clamp have made LK techniques easier and more predictable and have led to the innovation of another LK procedure, namely Bowman membrane transplant (BMT). In this article, we discuss the evolution of different surgical techniques, their principles, main outcomes, and limitations. To date, experience with BMT is limited, but DALK has become the gold standard for anterior LK. The EK procedures too have undergone a rapid transition from DSEK to DMEK and PDEK emerging as a viable option. Ultrathin-DSEK may still have a role in modern EK.

Citing Articles

Advancements in bioengineering for descemet membrane endothelial keratoplasty (DMEK).

Zwingelberg S, Karabiyik G, Gehle P, von Brandenstein M, Eibichova S, Lotz C NPJ Regen Med. 2025; 10(1):10.

PMID: 39952985 PMC: 11828897. DOI: 10.1038/s41536-025-00396-0.

Strategic Management of Descemet's Membrane Perforation During DALK in Advanced Keratoconus.

Gheorghe A, Onofrei A, Arghirescu A, Coleasa A, Tiran G, Dinu L Rom J Ophthalmol. 2025; 68(4):448-456.

PMID: 39936068 PMC: 11809823. DOI: 10.22336/rjo.2024.81.

Changing indications for keratoplasty: monocentric analysis of the past two decades.

Hoffmann J, Kammrath Betancor P, Maier P, Lapp T, Heinzelmann S, Bohringer D Graefes Arch Clin Exp Ophthalmol. 2024; .

PMID: 39297889 DOI: 10.1007/s00417-024-06639-y.

Microkeratome versus manually dissected donor tissue for Descemet stripping endothelial keratoplasty: A randomized prospective study.

Mali R, Priyadarshini S, Sahu S, Mohanty A, Das S Indian J Ophthalmol. 2024; 72(12):1728-1733.

PMID: 38990636 PMC: 11727928. DOI: 10.4103/IJO.IJO_3282_23.

Postoperative Astigmatism after Keratoplasty: A Systematic Review Meta-Analysis Based on PRISMA.

Kijonka M, Nowinska A, Wylegala E, Wylegala A, Wroblewska-Czajka E, Kryszan K J Clin Med. 2024; 13(11).

PMID: 38893017 PMC: 11172787. DOI: 10.3390/jcm13113306.

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