EK (DLEK, DSEK, DMEK): New Frontier in Cornea Surgery

Annu Rev Vis Sci. 2017 Sep 15;3:69-90. doi: 10.1146/annurev-vision-102016-061400. Epub 2017 Jul 11.


Endothelial keratoplasty (EK) has revolutionized treatment of corneal endothelial dysfunction. Compared with penetrating keratoplasty (PK), EK provides faster and more reliable visual rehabilitation while maintaining the eye's structural integrity. The number of EK procedures is growing annually and surpassed PK in the United States in 2012. The most widely used iteration, Descemet stripping endothelial keratoplasty (DSEK), implants healthy donor endothelium, Descemet membrane, and posterior stroma. Descemet membrane endothelial keratoplasty (DMEK) eliminates the donor stromal layer. Although more surgically challenging than DSEK, DMEK provides even faster visual rehabilitation and reduced risk of immunologic rejection, so its use is growing. Potential future alternatives to EK that could help address the unmet demand for donor corneas include removing central guttae and regenerating a central endothelial cell layer from healthy peripheral cells in patients with Fuchs' dystrophy or injecting cultured human corneal endothelial cells to rehabilitate eyes without residual healthy endothelium.

Keywords: DLEK; DMEK; DSEK; PDEK; endothelial keratoplasty; penetrating keratoplasty.

Publication types

  • Historical Article
  • Review
  • Research Support, N.I.H., Extramural

MeSH terms

  • Cataract Extraction / methods
  • Cornea / surgery*
  • Corneal Diseases / surgery*
  • Corneal Stroma / surgery
  • Corneal Transplantation / history
  • Corneal Transplantation / methods*
  • Corneal Transplantation / trends
  • Descemet Membrane / surgery
  • Descemet Stripping Endothelial Keratoplasty
  • Endothelium, Corneal / surgery
  • History, 20th Century
  • History, 21st Century
  • Humans
  • Laser Therapy / methods
  • Lasers, Excimer / therapeutic use