How good is transplantation of corneal parts compared with penetrating keratoplasty?

The concept of transplantation of corneal parts is to replace only diseased tissues, while leaving healthy host tissues intact. Advantages of the new surgical approaches include fast recovery, resistance to trauma, and less postoperative complications. Despite the theoretical benefits, however, only few data are available in terms of the pros and cons of the new surgical methods. In this review, we analyzed our data on deep anterior lamellar keratoplasty (DALK) and Descemet stripping automated endothelial keratoplasty (DSAEK). Difficulty of surgical procedure still remains in DALK, and intraoperative Descemet membrane (DM) rupture is a major concern. We recently introduced a new DM exposure technique: the double-bubble method. We also investigated the influence of DM rupture on graft survival and visual function. Other concerns in DALK are long-term stability of endothelial density and interface opacity. We also investigated safety and efficacy of subsequent cataract surgery and found that the surgery can be performed safely without significant intraoperative complications. Visual improvement was excellent, and endothelial density remained stable. Although recent increase of DSAEK is remarkable, refinements in surgical procedure are needed, especially in Asian small eyes. Recent developments in surgical technique and instruments in graft insertion are presented. DSAEK is advantageous in the management of postoperative complications, including suture-associated troubles, astigmatism, and epithelial damage. However, we encounter new complication such as graft dislocation. Surgical outcomes of our series and those of other institutes are discussed.