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- Descemet membrane endothelial keratoplasty
- descemet stripping endothelial keratoplasty
- posterior lamellar keratoplasty
- corneal transplantation
- visual acuity
- graft contraction
- graft thickness
Since 1998, we have introduced various concepts for endothelial keratoplasty, popularised as ‘deep lamellar endothelial keratoplasty’ (DLEK), ‘Descemet stripping (automated) endothelial keratoplasty’ (DSEK/DSAEK) and ‘Descemet membrane endothelial keratoplasty’ (DMEK).1 Large clinical studies on DSEK/DSAEK reported a best-corrected visual acuity (BCVA) averaging 20/40 (0.5) at 6 months after surgery, with only few cases reaching ≥20/25 (≥0.8).2 3 In a first series of DMEK surgeries for Fuchs endothelial dystrophy, a majority of cases reached ≥20/25 (≥0.8).4 Apparently, a cornea may obtain a better optical performance after transplantation of an isolated donor Descemet membrane and its endothelium in DMEK, than with a thicker graft also containing donor posterior stroma as used in DSEK/DSAEK.1 If so, compromised optical quality of the transplanted cornea may relate to the presence of donor stroma in DSEK grafts. In this letter, we describe a potential mechanism of how donor posterior stroma may limit final BCVA in endothelial keratoplasty, by progressive graft contraction.
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