Descemet’s stripping automated endothelial keratoplasty: past, present and future

Abstract

Descemet’s stripping automated endothelial keratoplasty (DSAEK) is the gold standard for the surgical treatment of corneal endothelial diseases. Following its introduction over the last decade, DSAEK has evolved, showing excellent results in a variety of pathologies; for example, Fuchs’ endothelial dystrophy, pseudophakic bullous keratopathy, endothelial failure after penetrating keratoplasty or iridocorneal endothelial syndrome. Since it involves the use of a small incision that replaces only the affected part of the cornea, one of the advantages of this procedure is the rapid visual recovery compared with penetrating keratoplasty. DSAEK also poses major technical challenges to corneal surgeons and novel improvements are under the scope of researchers, such as the use of cultivated human corneal endothelial cells and the development of specific inserter devices to insert the endothelial graft. Owing to this innovation in endothelial keratoplasty surgery, a new chapter in the long history and evolution of corneal transplantation is upon us.