Abstract
AbstractAccording to the German Keratoplasty Registry 2020 out of a total of 9042 keratoplasties, 31.2% are performed as penetrating keratoplasty (PKP), 3.0% as deep anterior lamellar keratoplasty (DALK) and 65.8% as posterior lamellar keratoplasty (98.3% DMEK vs. 1.7% DSAEK). To avoid the feared increase of astigmatism after suture removal, we have performed ‘nonmechanical’ 193 nm excimer laser trephination in over 5000 eyes since 1989 in Erlangen and Homburg/Saar. This non‐contact method avoids distortion, and results in lower objective astigmatism, higher regularity of topography and better visual acuity than manual trephination. Few published results after suture removal do not justify the huge technical and financial effort of femtosecond laser application for PKPespecially not in keratoconus. DALK saves good host endothelium, reduces the risk of immune reactions and may achieve favourable visual results, if intraoperatively Descemet's membrane is bared. To avoid disadvantages for the patient in case of the necessity for „conversion “to PKP, we propagate „Excimer laser assisted DALK“. For pure endothelial decompensation without stromal scars, today DMEK is supposed to be first choice. However, we do encourage each DMEK surgeon to standardize the surgical step‐by‐step procedure, to minimize donor loss and/or technical deficits that may lead to early or late graft failure and repeat keratoplasty.
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