Endothelial Transplant (Posterior Lamellar Keratoplasty and Deep Lamellar Endothelia Keratoplasty)

An exciting advance for people with diseased corneas is now available. For certain patients, posterior lamellar keratoplasty (PLK) and deep lamellar endothelial keratoplasty (DLEK) are new surgical options for the treatment of defective corneal pump cells. The most common indications for endothelial transplantation include Fuchs' Endothelial Dystrophy and corneal decompensation after cataract surgery.

The Endothelial Transplantation Procedure

Both PLK and DLEK involve replacing some of the defective inner layers of the cornea with healthy donated tissue. Both have a relatively small incision size when compared to traditional cornea transplants and offer a much lower risk of astigmatism. While both PLK and DLEK result in the placement of new pump cells inside the eye, the latter requires more dissection of the recipient and potentially more time in the operating room. PLK surgeons frequently perform an efficient stripping of the defective cells to prepare for insertion of the healthy endothelial pump cells.

Endothelial transplantation has the potential of rapid visual recovery while still maintaining the structural integrity of the eye. Frequently, two or less sutures are used during the entire procedure. The long-term risk of eye rupture from trauma appears to be much lower with this procedure than with traditional cornea transplants.

Postoperatively, patients should expect a very gradual recovery of vision. In fact, the best vision may not be obtained for six to 12 months or more following surgery. Vision may, however, be improved immediately after surgery. Patients are usually able to return to normal activities on the second day following surgery.

Endothelial transplantation can only be used to treat specific conditions of the cornea. A comprehensive examination of the cornea is necessary to determine if this new procedure is an appropriate alternative to traditional corneal transplantation.