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• W4387015614 abstract "The discovery of the pre-Descemet’s layer (Dua’s layer, PDL/DL), published in 2013, led to an improved understanding of corneal lamellar surgery and the innovation of three new surgical procedures, namely DALK-triple, suture management of acute corneal hydrops and pre-Descemet’s endothelial keratoplasty (PDEK). For corneal pathology that affects the endothelium, endothelial keratoplasty (EK) is now the norm. Descemet’s stripping endothelial keratoplasty (manual DSEK) and automated DSEK (DSAEK) revolutionised corneal transplantation. These procedures resulted in rapid visual recovery without any significant induced astigmatism and were free from sutures and suture-related problems. However, the best corrected visual acuity attained was usually limited to around 6/12. Descemet’s membrane (DM) endothelial keratoplasty (DMEK) became the next step forward and is today the gold standard procedure for endothelial pathology. It has all the advantages of EK but can restore vision to 6/6 or 6/5. The limitations of DMEK are the technical challenges in harvesting donor tissue, and un-scrolling it in the recipient’s eye. Young donor eyes have thinner DM, which is more adherent to the underlying tissue and scrolls tightly. The longer it takes and the greater the manoeuvres performed to unscroll the tissue, the greater is the endothelial cell loss. PDEK tissue is obtained by creating a type 1 big bubble (BB) by injecting air into the donor cornea. The wall of the BB, made of the endothelium, DM and PDL/DL, is excised and transplanted. Donor eyes of any age, including infants, can be used. These have higher endothelial cell counts. The DM is supported by the PDL/DL to which it is adherent, hence does not scroll as much as DM and is easier to unscroll and handle in the eye. This offers a significant advantage. However, as a type 1 BB is usually no more than 8.5–9 mm in diameter, PDEK tissue is relatively smaller than DMEK tissue. Another potential disadvantage is the inadvertent creation of a type 2 BB (lifting DM and endothelium only). This results from the passage of air through peripheral fenestrations in the PDL/DL (in normal donor eyes) into the plane between the PDL/DL and the DM. A type 2 BB would yield DMEK, not PDEK tissue. This can be avoided by the use of the PDEK clamp or the peripheral scoring technique. The surgical technique of insertion, unscrolling, centration and attachment of the graft to the cornea is similar for DMEK and PDEK. Clinical outcomes of DMEK and PDEK are also similar." @default.
• W4387015614 created "2023-09-26" @default.
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• W4387015614 date "2023-01-01" @default.
• W4387015614 modified "2023-09-26" @default.
• W4387015614 title "Pre-Descemets Endothelial Keratoplasty (PDEK): Science and Surgery" @default.
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• W4387015614 doi "https://doi.org/10.1007/978-3-031-32408-6_31" @default.
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