Use of Photorefractive Keratectomy Treated Donor Corneas for Endothelial Keratoplasty

357 Corneal transplantation has been widely performed since the first successful surgery was described by Zirm. Recent data from the Eye Bank Association of America (EBAA), the accredited organization that tracks donor quality and volume of surgeries performed anually in the United States, has shown that 46,253 corneal tissues were used for transplantation in 2014 domestically while 76,431 tissues were used worldwide.[1] However, penetrating keratoplasty (PKP) procedures have significantly decreased over the last decade, whereas the number of endothelial keratoplasties (EK) have increased. In fact, the number of EKs has superseded PKPs since 2012 in the United States. EK is now the preferred surgical option for patients with endothelial pathologies, such as Fuchs’ endothelial corneal dystrophy (FECD) and pseudophakic bullous keratopathy (PBK), due to reduced complication rates and accelerated time for visual rehabilitation.[1,2] According to the EBAA, the primary indication for EK is FECD.[1] The increasing world population and longer life expectancy has increased the incidence of endothelial pathologies such as FECD in the elderly population. Several EK procedures are currently being performed. Descemet’s Stripping Endothelial Keratoplasty (DSEK)[3] was initially developed for replacement of the endothelium and Descemet’s Membrane (DM) in a controlled fashion, without damaging the posterior corneal stroma. Further advancement led to Descemet’ Stripping Automated Endothelial Keratoplasty (DSAEK),[4] a variation of DSEK in which, the donor complex of posterior stroma, DM and endothelium are prepared with the assistance of a microkeratome. More recently Descemet Membrane Endothelial Keratoplasty (DMEK)[5] has been added to the armamentarium, which has the feature of replacing the DM and the dysfunctional endothelium without any donor stroma. Although visual outcomes, visual rehabilitation and rejection rates with DMEK have been Use of Photorefractive Keratectomy Treated Donor Corneas for Endothelial Keratoplasty