Cornea Transplantation: The New Era of Endothelial Keratoplasty

Corneal transplantation has evolved rapidly over the past decade, as surgeons strive to refine selective tissue transplantation to treat diseases that affect specific layers of the cornea. The first successful penetrating corneal transplantation was performed by Eduard Zirm in 1905. In 1931, Ramon Castroviejo, MD, while a fellow at Mayo Clinic, refined the techniques for penetrating keratoplasty (PK) familiar to cornea surgeons today. Although PK has been more popular than lamellar keratoplasty traditionally, the techniques for lamellar keratoplasty have advanced dramatically. At present, posterior lamellar (endothelial) keratoplasty is the treatment of choice for corneal endothelial disease, and deep anterior lamellar keratoplasty is strongly advocated for corneal stromal disease. The majority of corneal transplantations at Mayo Clinic are performed for patients with Fuchs endothelial dystrophy. “Our experience with Descemet stripping endothelial keratoplasty, or DSEK, for these patients has developed favorably over the past 6 years,” notes Sanjay V. Patel, MD, of the Department of Ophthalmology at Mayo Clinic in Rochester, Minnesota. “We have been fortunate to examine many of the patients receiving DSEK in our prospective evaluation of DSEK outcomes study, with 3 years of follow-up for many of the participants.”