Endothelial keratoplasty continues to evolve toward greater achievements

Endothelial keratoplasty has been one of the most remarkable advances in ophthalmology, rapidly evolving through progressive refinement and widely adopted all over the world. Today in the U.S., Europe and most parts of Asia, 90% of situations in which corneal transplantation is needed and the main problem is the endothelium are dealt with by endothelial keratoplasty techniques rather than full-thickness transplantation. It is particularly in the last 2 or 3 years that initial resistance to this surgery — which was considered a difficult procedure and not within everyone’s reach — has been decisively overcome. Nowadays, only very few corneal surgeons are unable to offer endothelial transplantation to their patients, either because they do not have the expertise or work in hospitals with limited facilities.Endothelial keratoplasty was quickly adopted in the U.S., where Descemet’s stripping automated endothelial keratoplasty became the gold standard. In Europe, where many surgeons were DSAEK-skeptic, the true shift occurred when Descemet’s membrane endothelial keratoplasty entered the scene. Something similar to the U.S. happened in Asia, although more and more surgeons are now converting to DMEK. Although no precise data are available concerning the relative proportion of DSAEK and DMEK, my perception is that DMEK currently accounts for about 25% of the endothelial procedures in the U.S., approximately 50% in Asia and about 60% in Europe. DMEK here has definitely overtaken DSAEK, especially in larger centers, and the majority of high-volume cornea surgeons in Europe are carrying out DMEK.