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New Perspectives on Lamellar Keratoplasty

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Abstract

Lamellar (anterior and posterior) keratoplasty entails the surgical replacement of diseased-only corneal tissue, while healthy host corneal tissue is preserved. Selective keratoplasty offers several advantages in comparison to penetrating keratoplasty such as a lower rate of graft rejection, less endothelial cell loss, faster/superior visual rehabilitation and enhanced resistance to closed injury. The surgical approach of “partial corneal transplantation” may be divided into anterior and posterior: techniques including superficial and deep anterior lamellar keratoplasty (SALK and DALK, respectively) and endothelial keratoplasty as well as Descemet stripping automated endothelial keratoplasty (DSAEK) and Descemet membrane endothelial keratoplasty (DMEK). These novel surgical procedures are rapidly becoming the preferred therapy option for specific corneal dysfunctions involving the corneal stroma (SALK, DALK), or corneal endothelium (DSAEK, DMEK). During the past decade, the continuing advancement of surgical techniques and the development of innovative surgical instruments have significantly enhanced corneal transplantation. Lamellar keratoplasty techniques facilitate corneal surgery, provide patients with superior outcomes and can successfully restore vision in corneal-related blindness. Nevertheless, more long-term evidence is needed to better evaluate these promising new techniques.

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References

  1. Dorrepaal SJ, Cao KY, Slomovic AR. Indications for penetrating keratoplasty in a tertiary referral centre in Canada, 1996–2004. Can J Ophthalmol. 2007;42:244–50.

    PubMed  Google Scholar 

  2. Han DC, Mehta JS, Por YM, Htoon HM, Tan DT. Comparison of outcomes of lamellar keratoplasty and penetrating keratoplasty in keratoconus. Am J Ophthalmol. 2009;148:744–51.

    PubMed  Google Scholar 

  3. Williams KA, Muehlberg SM, Lewis RF, Coster DJ. Influence of advanced recipient and donor age on the outcome of corneal transplantation. Australian Corneal Graft Registry. Br J Ophthalmol. 1997;81:835–9.

    CAS  PubMed Central  PubMed  Google Scholar 

  4. Patel SV, Hodge DO, Bourne WM. Corneal endothelium and postoperative outcomes 15 years after penetrating keratoplasty. Am J Ophthalmol. 2005;139:311–9.

    PubMed  Google Scholar 

  5. Borderie VM, Sandali O, Bullet J, Gaujoux T, Touzeau O, Laroche L. Long-term results of deep anterior lamellar versus penetrating keratoplasty. Ophthalmology. 2012;119:249–55.

    PubMed  Google Scholar 

  6. Gorovoy MS. Descemet-stripping automated endothelial keratoplasty. Cornea. 2006;25:886–9.

    PubMed  Google Scholar 

  7. Melles GR, Ong TS, Ververs B, van der Wees J. Descemet membrane endothelial keratoplasty (DMEK). Cornea. 2006;25:987–90.

    PubMed  Google Scholar 

  8. Malbran E. Lamellar keratoplasty in keratoconus. Int Ophthalmol Clin. 1966;6:99–109.

    CAS  PubMed  Google Scholar 

  9. Tan DT, Mehta JS. Future directions in lamellar corneal transplantation. Cornea. 2007;26(9 Suppl 1):S21–8.

    PubMed  Google Scholar 

  10. El-Danasoury A. Big bubble deep anterior lamellar keratoplasty (BB-DALK). Int Ophthalmol Clin. 2013;53:41–53.

    PubMed  Google Scholar 

  11. Funnel CL, Ball J, Noble BA. Comparative cohort study of the outcomes of deep lamellar keratoplasty and penetrating keratoplasty for keratoconus. Eye. 2006;20:527–32.

    Google Scholar 

  12. Vajpayee RB, Tyagi J, Sharma N, Kumar N, Jhanji V, Titiyal JS. Deep anterior lamellar keratoplasty by big bubble technique for treatment of corneal stromal dystrophies. Am J Ophthalmol. 2007;143:954–7.

    PubMed  Google Scholar 

  13. Rad AS, Jabbarvand M, Saifi N. Progressive keratectasia after laser in situ keratomileusis. J Refract Surg. 2004;5(Suppl):S718–22.

    Google Scholar 

  14. Tan D, Ang LP. Automated lamellar therapeutic keratoplasty for post-PRK corneal scarring and thinning. Am J Ophthalmol. 2004;138:1067–9.

    PubMed  Google Scholar 

  15. Yao YF, Zhang B, Zhou P, et al. Autologous limbal grafting combined with deep lamellar keratoplasty in unilateral eye with severe chemical injury. Ophthalmology. 2002;109:2011–7.

    PubMed  Google Scholar 

  16. Venkataratnam S, Ganekal S, Dorairaj S, Kolhatkar T, Jhanji V. Big-bubble deep anterior lamellar keratoplasty for post-keratitis and post-traumatic corneal stromal scars. Clin Exp Ophthalmol. 2012;40(6):537–41.

    Google Scholar 

  17. Wiley LA, Joseph MA, Pemberton JD. Microkeratome assisted anterior lamellar keratoplasty. Arch Ophthalmol. 2008;126:404–8.

    PubMed  Google Scholar 

  18. Patel AK, Scorcia V, Kadyan A, Lapenna L, Ponzin D, Busin M. Microkeratome-assisted superficial anterior lamellar keratoplasty for anterior stromal corneal opacities after penetrating keratoplasty. Cornea. 2012;31:101–5.

    PubMed  Google Scholar 

  19. Takács AI, Nagy ZZ. Microkeratome-assisted anterior lamellar keratoplasty for the removal of corneal scar, caused by pterygium. Orv Hetil. 2009;21(150):1167–71.

    Google Scholar 

  20. Suwan-Apichon O, Reyes JM, Griffin NB, Barker J, Gore P, Chuck RS. Microkeratome versus femtosecond laser predissection of corneal grafts for anterior and posterior lamellar keratoplasty. Cornea. 2006;25:966–8.

    PubMed  Google Scholar 

  21. Yoo SH, Kymionis GD, Koreishi A, et al. Femtosecond laser assisted sutureless anterior lamellar keratoplasty. Ophthalmology. 2008;115:1303–7.

    PubMed  Google Scholar 

  22. Shousha MA, Yoo SH, Kymionis GD, et al. Long-term results of femtosecond laser-assisted sutureless anterior lamellar keratoplasty. Ophthalmology. 2011;118:315–23.

    PubMed  Google Scholar 

  23. Bonfadini G, Moreira H, Jun AS, et al. Modified femtosecond laser-assisted sutureless anterior lamellar keratoplasty. Cornea. 2013;32:533–7.

    PubMed  Google Scholar 

  24. Reinhart WJ, Musch DC, Jacobs DS, Lee WB, Kaufman SC, Shtein RM. Deep anterior lamellar keratoplasty as an alternative to penetrating keratoplasty a report by the American Academy of Ophthalmology. Ophthalmology. 2011;118:209–18.

    PubMed  Google Scholar 

  25. Den S, Kawashima M, Shimmura M, Imai Y, Satake Y, Shimazaki J. How good is transplantation of corneal parts compared with penetrating keratoplasty? Cornea. 2010;29(Suppl 1):S48–51.

    PubMed  Google Scholar 

  26. Coster DJ, Lowe MT, Keane MC, Williams KA; Australian Corneal Graft Registry Contributors. A comparison of lamellar and penetrating keratoplasty outcomes: a registry study. Ophthalmology. 2014;121(5):979–87.

  27. Anwar M. Dissection technique in lamellar keratoplasty. Br J Ophthalmol. 1972;56:711–3.

    CAS  PubMed Central  PubMed  Google Scholar 

  28. Sugita J, Kondo J. Deep lamellar keratoplasty with complete removal of pathological stroma for vision improvement. Br J Ophthalmol. 1997;81:184–8.

    CAS  PubMed Central  PubMed  Google Scholar 

  29. Melles GR, Lander F, Rietveld FJ, Remeijer L, Beekhuis WH, Binder PS. A new surgical technique for deep stromal, anterior lamellar keratoplasty. Br J Ophthalmol. 1999;83:327–33.

    CAS  PubMed Central  PubMed  Google Scholar 

  30. Melles GR, Remeijer L, Geerards AJ, Beekhuis WH. A quick surgical technique for deep, anterior lamellar keratoplasty using visco-dissection. Cornea. 2000;19:427–32.

    CAS  PubMed  Google Scholar 

  31. Archila EA. Deep lamellar keratoplasty dissection of host tissue with intrastromal air injection. Cornea 1984–1985;3:217–8.

  32. Anwar M, Teichmann KD. Big-bubble technique to bare Descemet’s membrane in anterior lamellar keratoplasty. J Cataract Refract Surg. 2002;28:398–403.

    PubMed  Google Scholar 

  33. Parthasarathy A, Por YM, Tan DT. Use of a “small-bubble technique” to increase the success of Anwar’s “big-bubble technique” for deep lamellar keratoplasty with complete baring of Descemet’s membrane. Br J Ophthalmol. 2007;91:1369–73.

    PubMed Central  PubMed  Google Scholar 

  34. Behrooz MJ, Daneshgar F. “Large-bubble” modification of the “big-bubble” technique for performing maximum-depth anterior lamellar keratoplasty. Cornea. 2010;29:820–4.

    PubMed  Google Scholar 

  35. Shimazaki J. Double-bubble technique to facilitate Descemet membrane exposure in deep anterior lamellar keratoplasty. J Cataract Refract Surg. 2010;36:193–6.

    PubMed  Google Scholar 

  36. Price FW Jr, Price MR, Grandin JC, Kwon R. Deep anterior lamellar keratoplasty with femtosecond-laser zigzag incisions. J Cataract Refract Surg. 2009;35:804–8.

    PubMed  Google Scholar 

  37. Farid M, Steinert RF. Deep anterior lamellar keratoplasty performed with the femtosecond laser zigzag incision for the treatment of stromal corneal pathology and ectatic disease. J Cataract Refract Surg. 2009;35:809–13.

    PubMed  Google Scholar 

  38. Almousa R, Samaras KE, Khan S, Lake DB, Daya SM. Femtosecond laser-assisted lamellar keratoplasty (FSLK) for anterior corneal stromal diseases. Int Ophthalmol. 2013. [Epub ahead of print].

  39. Chamberlain W, Cabezas M. Femtosecond-assisted deep anterior lamellar keratoplasty using big-bubble technique in a cornea with 16 radial keratotomy incisions. Cornea. 2011;30:233–6.

    PubMed  Google Scholar 

  40. Sharma N, Kumar C, Mannan R, Titiyal JS, Vajpayee RB. Surgical technique of deep anterior lamellar keratoplasty in descemetoceles. Cornea. 2010;29:1448–51.

    PubMed  Google Scholar 

  41. Ramamurthi S, Ramaesh K. Surgical management of healed hydrops: a novel modification of deep anterior lamellar keratoplasty. Cornea. 2011;30:180–3.

    CAS  PubMed  Google Scholar 

  42. Sarnicola V, Toro P, Gentile D, Hannush SB. Descemetic DALK and predescemetic DALK: outcomes in 236 cases of keratoconus. Cornea. 2010;29:53–9.

    PubMed  Google Scholar 

  43. Feizi S, Javadi MA, Jamali H, Mirbabaee F. Deep anterior lamellar keratoplasty in patients with keratoconus: big-bubble technique. Cornea. 2010;29:177–82.

    PubMed  Google Scholar 

  44. Fogla R, Padmanabham P. Results of deep lamellar keratoplasty using the big-bubble technique in patients with keratoconus. Am J Ophthalmol. 2006;141:254–9.

    PubMed  Google Scholar 

  45. Smadja D, Colin J, Krueger RR, et al. Outcomes of deep anterior lamellar keratoplasty for keratoconus: learning curve and advantages of the big bubble technique. Cornea. 2012;31:859–63.

    PubMed  Google Scholar 

  46. Fontana L, Parente G, Tassinari G. Clinical outcomes after deep anterior lamellar keratoplasty using the big bubble technique in patients with keratoconus. Am J Ophthalmol. 2007;143:117–24.

    PubMed  Google Scholar 

  47. Kubaloglu A, Sari ES, Unal M, et al. Long-term results of deep anterior lamellar keratoplasty for the treatment of keratoconus. Am J Ophthalmol. 2011;151:760–7.

    PubMed  Google Scholar 

  48. Noble BA, Agarwal A, Collins C, Saldana M, Brogden PR, Zuberbuhler B. Deep anterior lamellar keratoplasty (DALK). Visual outcomes and complications for a heterogenous group of corneal pathologies. Cornea. 2007;26:59–64.

    PubMed  Google Scholar 

  49. Arslan OS, Ünal M, Tuncer I, Yücel I. Deep anterior lamellar keratoplasty using big-bubble technique for treatment of corneal stromal scars. Cornea. 2011;30:629–33.

    PubMed  Google Scholar 

  50. Cheng YY, Visser N, Schouten JS, et al. Endothelial cell loss and visual outcome of deep anterior lamellar keratoplasty versus penetrating keratoplasty: a randomized multicenter clinical trial. Ophthalmology. 2011;118:302–9.

    PubMed  Google Scholar 

  51. Van Dooren BT, Mulder PG, Nieuwendaal CP, Beekhuis WH, Melles GR. Endothelial cell density after deep anterior lamellar keratoplasty (Melles Technique). Am J Ophthalmol. 2004;137:397–400.

    PubMed  Google Scholar 

  52. Bourne WM. Cellular changes in transplanted human corneas: Castroviejo lecture. Cornea. 2001;20:560–9.

    CAS  PubMed  Google Scholar 

  53. Ashar JN, Pahuja S, Ramappa M, Vaddavalli PK, Chaurasia S, Garg P. Deep anterior lamellar keratoplasty in children. Am J Ophthalmol. 2013;155:570–4.

    PubMed  Google Scholar 

  54. Balestrazzi A, Malandrini A, Traversi C, Martone G, Caporossi A. Air-guided manual deep anterior lamellar keratoplasty: long-term results and confocal microscopic findings. Eu J Ophthalmol. 2007;17:897–903.

    CAS  Google Scholar 

  55. Marchini G, Mastropasqua L, Pedrotti E, Nubile M, Ciancaglini M, Sbabo A. Deep lamellar keratoplasty by intracorneal dissection: A prospective clinical and confocal microscopic study. Ophthalmology. 2006;113:1289–300.

    PubMed  Google Scholar 

  56. Farias R, Barbosa L, Lima A, et al. Deep anterior lamellar transplant using lyophilized and Optisol corneas in patients with keratoconus. Cornea. 2008;27:1030–6.

    PubMed  Google Scholar 

  57. Feizi S, Javadi MA, Kanavi MR. Cellular changes of donor corneal tissue after deep anterior lamellar keratoplasty versus penetrating keratoplasty in eyes with keratoconus: a confocal study. Cornea. 2010;29:866–70.

    PubMed  Google Scholar 

  58. Coombes AG, Kirwan JF, Rostron CK. Deep lamellar keratoplasty with lyophilised tissue in the management of keratoconus. Br J Ophthalmol. 2001;85:788–91.

    CAS  PubMed Central  PubMed  Google Scholar 

  59. Tsubota K, Kaido M, Moden Y, Satake Y, Bissen-Miyajima H, Shimazaki J. A new surgical technique for deep lamellar keratoplasty with single running suture adjustment. Am J Ophthalmol. 1998;126:1–8.

    CAS  PubMed  Google Scholar 

  60. Bhojwani RD, Noble B, Chakrabarty AK, Stewart OG. Sequestered viscoelastic after deep lamellar keratoplasty using viscodissection. Cornea. 2003;22:371–3.

    PubMed  Google Scholar 

  61. Watson SL, Ramsay A, Dart JK, Bunce C, Craig E. Comparison of deep lamellar keratoplasty and penetrating keratoplasty in patients with keratoconus. Ophthalmology. 2004;111:1676–82.

    PubMed  Google Scholar 

  62. Watson SL, Tuft SJ, Dart JK. Patterns of rejection after deep lamellar keratoplasty. Ophthalmology. 2006;113:556–60.

    PubMed  Google Scholar 

  63. Al-Torbak AA, Al-Motowa S, Al-Assiri A, Al-Kharashi S, Al-Shahwan S, Al-Mezaine H, Teichmann K. Deep anterior lamellar keratoplasty for keratoconus. Cornea. 2006;25:408–12.

    PubMed  Google Scholar 

  64. Maurino V, Allan BD, Stevens JD, Tuft SJ. Fixed dilated pupil (Urrets-Zavalia syndrome) after air/gas injection after deep lamellar keratoplasty for keratoconus. Am J Ophthalmol. 2002;133:266–8.

    PubMed  Google Scholar 

  65. Niknam S, Rajabi MT. Fixed dilated pupil (urrets zavalia syndrome) after deep anterior lamellar keratoplasty. Cornea. 2009;28:1187–90.

    PubMed  Google Scholar 

  66. Kanavi MR, Foroutan AR, Kamel MR, Afsar N, Javadi MA. Candida interface keratitis after deep anterior lamellar keratoplasty: clinical, microbiologic, histopathologic, and confocal microscopic reports. Cornea. 2007;26:913–6.

    PubMed  Google Scholar 

  67. Krumeich JH, Knülle A, Krumeich BM. Deep anterior lamellar (DALK) vs. penetrating keratoplasty (PKP): a clinical and statistical analysis. Klin Monbl Augenheilkd. 2008;225(7):637–48.

    CAS  PubMed  Google Scholar 

  68. Melles GR, Eggink FA, Lander F, Pels E, Rietveld FJ, Beekhuis WH, Binder PS. A surgical technique for posterior lamellar keratoplasty. Cornea. 1998;17:618–26.

    CAS  PubMed  Google Scholar 

  69. Melles GR, Lander F, Nieuwendaal C. Sutureless, posterior lamellar keratoplasty: a case report of a modified technique. Cornea. 2002;21:325–7.

    PubMed  Google Scholar 

  70. Terry MA, Ousley PJ. Deep lamellar endothelial keratoplasty in the first United States patients: early clinical results. Cornea. 2001;20:239–43.

    CAS  PubMed  Google Scholar 

  71. Terry MA, Ousley PJ. Small-incision deep lamellar endothelial keratoplasty (DLEK): six-month results in the first prospective clinical study. Cornea. 2005;24:59–65.

    PubMed  Google Scholar 

  72. Price FW Jr, Price MO. Descemet’s stripping with endothelial keratoplasty in 50 eyes: a refractive neutral corneal transplant. J Refract Surg. 2005;21:339–45.

    PubMed  Google Scholar 

  73. Arenas E, Esquenazi S, Anwar M, Terry M. Lamellar corneal transplantation. Surv Ophthalmol. 2012;57:510–29.

    PubMed  Google Scholar 

  74. Price MO, Price FW Jr. Descemet stripping with endothelial keratoplasty for treatment of iridocorneal endothelial syndrome. Cornea. 2007;26:493–7.

    PubMed  Google Scholar 

  75. Bromley JG, Randleman JB, Stone D, Stulting RD, Grossniklaus HE. Clinicopathologic findings in iridocorneal endothelial syndrome and posterior polymorphous membranous dystrophy after Descemet stripping automated endothelial keratoplasty. Cornea. 2012;31:1060–4.

    PubMed  Google Scholar 

  76. Pineda R 2nd, Jain V, Shome D, Hunter DC, Natarajan S. Descemet’s stripping endothelial keratoplasty: is it an option for congenital hereditary endothelial dystrophy? Int Ophthalmol. 2010;30:307–10.

    PubMed  Google Scholar 

  77. Anshu A, Price MO, Tan DT, Price FW Jr. Endothelial keratoplasty: a revolution in evolution. Surv Ophthalmol. 2012;57:236–52.

    PubMed  Google Scholar 

  78. Busin M, Patel AK, Scorcia V, Ponzin D. Microkeratome assisted preparation of ultrathin grafts for descemet stripping automated endothelial keratoplasty. Invest Ophthalmol Vis Sci. 2012;53:521–4.

    PubMed  Google Scholar 

  79. Thomas PB, Mukherjee AN, O’Donovan D, Rajan MS. Preconditioned donor corneal thickness for microthin endothelial keratoplasty. Cornea. 2013;32(7):e173–8.

    PubMed  Google Scholar 

  80. Van Cleynenbreugel H, Remeijer L, Hillenaar T. Descemet stripping automated endothelial keratoplasty: effect of intraoperative lenticule thickness on visual outcome and endothelial cell density. Cornea. 2011;30(11):1195–200.

    PubMed  Google Scholar 

  81. Yoo SH, Kymionis GD, Deobhakta AA, et al. One-year results and anterior segment optical coherence tomography findings of Descemet stripping automated endothelial keratoplasty combined with phacoemulsification. Arch Ophthalmol. 2008;126:1052–5.

    PubMed  Google Scholar 

  82. Sikder S, Nordgren RN, Neravetla SR, Moshirfar M. Ultra-thin donor tissue preparation for endothelial keratoplasty with a double-pass microkeratome. Am J Ophthalmol. 2011;152(2):202–8.

    PubMed  Google Scholar 

  83. Hsu M, Hereth WL, Moshirfar M. Double-pass microkeratome technique for ultra-thin graft preparation in Descemet’s stripping automated endothelial keratoplasty. Clin Ophthalmol. 2012;6:425–32.

    PubMed Central  PubMed  Google Scholar 

  84. Cheng YY, Pels E, Nuijts RM. Femtosecond-laser-assisted Descemet’s stripping endothelial keratoplasty. J Cataract Refract Surg. 2007;33(1):152–5.

    PubMed  Google Scholar 

  85. Neff KD, Biber JM, Holland EJ. Comparison of central corneal graft thickness to visual acuity outcomes in endothelial keratoplasty. Cornea. 2011;30(4):388–91.

    PubMed  Google Scholar 

  86. Bahar I, Kaiserman I, Levinger E, Sansanayudh W, Slomovic AR, Rootman DS. Retrospective contralateral study comparing descemet stripping automated endothelial keratoplasty with penetrating keratoplasty. Cornea. 2009;28:485–8.

    PubMed  Google Scholar 

  87. Lee WB, Jacobs DS, Musch DC, Kaufman SC, Reinhart WJ, Shtein RM. Descemet’s stripping endothelial keratoplasty: safety and outcomes: a report by the American Academy of Ophthalmology. Ophthalmology. 2009;116:1818–30.

    PubMed  Google Scholar 

  88. Busin M, Bhatt PR, Scorcia V. A modified technique for descemet membrane stripping automated endothelial keratoplasty to minimize endothelial cell loss. Arch Ophthalmol. 2008;126:1133–7.

    PubMed  Google Scholar 

  89. Covert DJ, Koenig SB. Descemet stripping and automated endothelial keratoplasty (DSAEK) in eyes with failed penetrating keratoplasty. Cornea. 2007;26:692–6.

    PubMed  Google Scholar 

  90. Covert DJ, Koenig SB. New triple procedure: Descemet’s stripping and automated endothelial keratoplasty combined with phacoemulsification and intraocular lens implantation. Ophthalmology. 2007;114:1272–7.

    PubMed  Google Scholar 

  91. Terry MA, Shamie N, Chen ES, et al. Endothelial keratoplasty: the influence of preoperative donor endothelial cell densities on dislocation, primary graft failure, and 1-year cell counts. Cornea. 2008;27:1131–7.

    PubMed  Google Scholar 

  92. Terry MA, Chen ES, Shamie N, et al. Endothelial cell loss after Descemet’s stripping endothelial keratoplasty in a large prospective series. Ophthalmology. 2008;115:488–96.

    PubMed  Google Scholar 

  93. Price MO, Price FW Jr. Endothelial cell loss after Descemet stripping with endothelial keratoplasty: influencing factors and 2-year trend. Ophthalmology. 2008;115:857–65.

    PubMed  Google Scholar 

  94. Price MO, Gorovoy M, Price FW Jr, Benetz BA, Menegay HJ, Lass JH. Descemet’s stripping automated endothelial keratoplasty: three-year graft and endothelial cell survival compared with penetrating keratoplasty. Ophthalmology. 2013;120:246–51.

    PubMed Central  PubMed  Google Scholar 

  95. Streilein JW, Yamada J, Dana MR, Ksander BR. Anterior chamber-associated immune deviation, ocular immune privilege, and orthotopic corneal allografts. Transpl Proc. 1999;31(3):1472–5.

    CAS  Google Scholar 

  96. Fernandez MM, Buckley EG, Afshari NA. Descemet stripping automated endothelial keratoplasty in a child. J AAPOS. 2008;12(3):314–6.

    PubMed  Google Scholar 

  97. Kymionis GD, Kankariya VP, Diakonis VF, Karavitaki AE, Siganos CS, Pallikaris IG. Descemet stripping automated endothelial keratoplasty in a child after failed penetrating keratoplasty. J AAPOS. 2012;16:95–6.

    PubMed  Google Scholar 

  98. Kymionis GD, Kontadakis GA. Descemet stripping endothelial keratoplasty for a failed penetrating keratoplasty graft in a pseudophakic patient with a toric intraocular lens: a case report. BMC Ophthalmol. 2013;30(13):64.

    Google Scholar 

  99. Suh LH, Yoo SH, Deobhakta A, et al. Complications of Descemet’s stripping with automated endothelial keratoplasty: survey of 118 eyes at One Institute. Ophthalmology. 2008;115:1517–24.

    PubMed  Google Scholar 

  100. Prasher P, Muftuoglu O, Hsiao ML, Bowman RW, Hogan RN, Mootha VV. Epithelial downgrowth after descemet stripping automated endothelial keratoplasty. Cornea. 2009;28:708–11.

    PubMed  Google Scholar 

  101. Koenig SB, Wirostko WJ, Fish RI, Covert DJ. Candida keratitis after Descemet stripping and automated endothelial keratoplasty. Cornea. 2009;28:471–3.

    PubMed  Google Scholar 

  102. Chang V, Karp CL, Yoo SH, et al. Mycobacterium abscessus endophthalmitis after Descemet’s stripping with automated endothelial keratoplasty. Cornea. 2010;29:586–9.

    PubMed  Google Scholar 

  103. Lie JT, Birbal R, Ham L, van der Wees J, Melles GR. Donor tissue preparation for Descemet membrane endothelial keratoplasty. J Cataract Refract Surg. 2008;34:1578–83.

    PubMed  Google Scholar 

  104. Price MO, Giebel AW, Fairchild KM, et al. Descemet’s membrane endothelial keratoplasty: prospective multicenter study of visual and refractive outcomes and endothelial survival. Ophthalmology. 2009;116:2361–8.

    PubMed  Google Scholar 

  105. McCauley MB, Price MO, Fairchild KM, Price DA, Price FW Jr. Prospective study of visual outcomes and endothelial survival with Descemet membrane automated endothelial keratoplasty. Cornea. 2011;30:315–9.

    PubMed  Google Scholar 

  106. McCauley MB, Price FW Jr, Price MO. Descemet membrane automated endothelial keratoplasty: hybrid technique combining DSAEK stability with DMEK visual results. J Cataract Refract Surg. 2009;35:1659–64.

    PubMed  Google Scholar 

  107. Kymionis GD, Yoo SH, Diakonis VF, Grentzelos MA, Naoumidi I, Pallikaris IG. Automated donor tissue preparation for descemet membrane automated endothelial keratoplasty (DMAEK): an experimental study. Ophthalmic Surg Lasers Imaging. 2011;42:158–61.

    PubMed  Google Scholar 

  108. Ham L, Balachandran C, Verschoor CA, et al. Visual rehabilitation rate after isolated descemet membrane transplantation: Descemet membrane endothelial keratoplasty. Arch Ophthalmol. 2009;127:252–5.

    PubMed  Google Scholar 

  109. Ham L, Dapena I, van Luijk C, et al. Descemet membrane endothelial keratoplasty (DMEK) for Fuchs endothelial dystrophy: review of the first 50 consecutive cases. Eye (Lond). 2009;23:1990–8.

    CAS  Google Scholar 

  110. Laaser K, Bachmann BO, Horn FK, et al. Donor tissue culture conditions and outcome after Descemet membrane endothelial keratoplasty. Am J Ophthalmol. 2011;151:1007–18.

    PubMed  Google Scholar 

  111. Ham L, van Luijk C, Dapena I, et al. Endothelial cell density after descemet membrane endothelial keratoplasty: 1 to 2-year follow-up. Am J Ophthalmol. 2009;148:521–7.

    PubMed  Google Scholar 

  112. Anshu A, Price MO, Price FW. Risk of corneal transplant rejection significantly reduced with Descemet membrane endothelial keratoplasty. Opthalmology. 2012;119:536–40.

    Google Scholar 

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Acknowledgments

No funding or sponsorship was received for this study or publication of this article. All named authors meet the ICMJE criteria for authorship for this manuscript, take responsibility for the integrity of the work as a whole, and have given final approval for the version to be published.

Conflict of interest

G. D. Kymionis, D. G. Mikropoulos, D. M. Portaliou, K. G. Boboridis, I. C. Voudouragkaki, N. D. Dragoumis and A. G. P. Konstas declare no conflict of interest.

Compliance with ethics guidelines

This article does not contain any new studies with human or animal subjects performed by any of the authors.

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Authors and Affiliations

  1. Vardinoyiannion Eye Institute of Crete (VEIC), Faculty of Medicine, University of Crete, Heraklion, Crete, Greece

    George D. Kymionis & Dimitra M. Portaliou

  2. Bascom Palmer Eye Institute, Miller School of Medicine, University of Miami, Miami, FL, USA

    George D. Kymionis & Dimitra M. Portaliou

  3. 3rd University Department of Ophthalmology, Aristotle University of Thessaloniki, Thessaloniki, Greece

    Dimitrios G. Mikropoulos & Anastasios G. P. Konstas

  4. 1st University Department of Ophthalmology, Aristotle University of Thessaloniki, 1 Kyriakidi Street, 546 36, Thessaloniki, Greece

    Kostantinos G. Boboridis, Irini C. Voudouragkaki, Nikolaos D. Dragoumis & Anastasios G. P. Konstas

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  4. Kostantinos G. Boboridis
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Correspondence to Anastasios G. P. Konstas.

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Kymionis, G.D., Mikropoulos, D.G., Portaliou, D.M. et al. New Perspectives on Lamellar Keratoplasty. Adv Ther 31, 494–511 (2014). https://doi.org/10.1007/s12325-014-0121-0

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