Comparison of Clinical Outcomes of All Endothelial Keratoplasty: A Systematic Review of Literature

Endothelial keratoplasty (EK) techniques have nearly replaced the penetrating keratoplasty in the last two decades [1–5]. Graft rejection is one of the key causes for secondary failure whose prevalence is high following full-thickness keratoplasty [6, 7]. On the other hand, the lamellar keratoplasties, where the diseased cornea alone is transplanted, have fewer incidences of rejection [8]. Endothelial grafts have the advantage of harbouring less or no stromal tissue adherent to the endothelium; hence, the incidence of failure due to immune rejection has been reported to be less [1–5]. Other superior benefits of endothelial grafts are the ease of surgery, early visual rehabilitation, and less suture-related astigmatism. With the introduction of pneumatic dissection, the donor tissue harvesting has been made simpler for the surgeons without advanced instrumentation [6–8]. Restoring the function in a decompensated cornea by means of Descemet’s membrane endothelial keratoplasty (DMEK), Descemet’s stripping automated endothelial keratoplasty (DSAEK), ultrathin DSAEK and recently Pre-Descemet’s endothelial keratoplasty (PDEK) are in vogue [7–14]. In this chapter, we do a literature search and limited meta-analysis of surgical outcomes of the recent EK techniques, namely the Descemet’s membrane endothelial keratoplasty (DMEK), Descemet’s stripping automated endothelial keratoplasty (DSAEK), ultrathin DSAEK and Pre-Descemet’s endothelial keratoplasty (PDEK).