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Chapter-35 Descemetorhexis with Endokeratoplasty

BOOK TITLE: Surgical Techniques in Anterior and Posterior Lamellar Corneal Surgery

Author
1. John Thomas
ISBN
9788180616051
DOI
10.5005/jp/books/10883_35
Edition
1/e
Publishing Year
2006
Pages
8
Author Affiliations
1. Loyola University at Chicago, Maywood, Illinois, USA, Cornea Institute of Illinois and Indiana, Tinley Park and Oak Lawn, Illinois, Merriville, Indiana, USA, Chicago Cornea Research Center, Tinley Park, Illinois, USA, Loyola University at Chicago, Maywood, Illinois, USA, Loyola University at Chicago, Maywood, Illinois, USA, Thomas John Vision Institute, P.C., Oak Brook, Tinley Park & Oak Lawn, Illinois, USA, Chicago Cornea Research Center, Tinley Park, Illinois, USA
Chapter keywords

Abstract

The term descemetorhexis (DX) was first introduced by Sinha et al in 2003. They used trypan blue (Vision Blue—FDA approved in the United States) to enhance the visibility of Descemet’s membrane and used a controlled circular tearing technique to excise the retained Descemet’s membrane following a penetrating keratoplasty (PKP). They rationalized that both the lens capsule and Descemet’s membrane are basement membranes; and since capsulorhexis was commonly used in cataract surgery, they used a similar technique on the Descemet’s membrane and called it DX. Subsequently, others have used a similar technique to excise Descemet’s membrane from a recipient cornea. Endokeratoplasty refers to transplantation of a thin donor corneal disk comprising of donor stroma, Descemet’s membrane, and a functional, healthy endothelium to the recipient cornea. The author wishes to reserve the term endokera­toplasty only for transplantation of a thin donor disk comprising of deep stroma, Descemet’s membrane and endothelium onto recipient cornea after removal of recipient endothelium and Descemet’s membrane by descemetorhexis as described recently by Melles et al. Recent introduction of clinically functional, selective tissue corneal transplantation (STCT; author’s terminology), into the arena of corneal surgery has instigated a tsunamic wave of interest in this field among corneal surgeons all over the world. Deep lamellar endothelial keratoplasty (DLEK) was one such STCT that was clinically successful with regard to a functional donor endothelium, and stromal integration between the donor and recipient corneas. In DLEK, the donor cornel disk is initially held in place with an air-bubble. The author used the term “stitchless corneal transplantation” or sutureless corneal transplantation (no corneal sutures) for this technique described by Melles et al. With continued experience and refinements with the technique of DLEK, Melles et al introduced the next step in STCT, namely replacement of only the recipient Descemet’s membrane (DM) and endothelium with the donor disk comprising of deep stroma, DM and endothelium. These evolving surgical techniques need standar­dization of terminologies. Further, continued studies are required to compare STCT to the gold standard, namely full-thickness penetrating keratoplasty (PKP).

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