Endothelial replacement: the limbal pocket approach.

The limbal pocket approach to endothelial replacement shows extraordinary promise in fulfilling the ideal goals of surgical treatment for endothelial dysfunction. From its inception, DLEK surgery has demonstrated that, by preserving the limbus and eliminating surface corneal incisions and sutures, the corneal topography can be stabilized with little change from preoperative measurements of astigmatism and corneal power. The surgical dissection planes of DLEK surgery are inherently stronger than that of PK or any other form of endothelial replacement, allowing early stability of the refraction and making the eye safer from blunt trauma over the long term. Further work with DLEK must be performed in perfecting the optical properties of the stromal interface before this technique can be used widely; however, as technology and techniques improve, DLEK surgery holds the promise of being the ideal method for endothelial replacement in the 21st century.