Abstract
Since 2000, endothelial keratoplasty (EK) in its various forms has largely eclipsed penetrating keratoplasty (PK) as the procedure of choice in the primary treatment for corneal endothelial failure secondary to Fuchs dystrophy [1]. Advantages include safer surgery under local anaesthetic and early functional visual rehabilitation – both of particular benefit in the older age group comprising the majority of patients with endothelial failure. Additional advantages include preservation of eye wall strength, refractive shape, and freedom from suture-related complications. Although primary transplantation for Fuchs dystrophy is now predominantly by EK, a sizeable cohort of Fuchs dystrophy cases treated initially with PK remains. The advantages of primary EK mostly hold true for EK surgery after failed PK, but a number of additional considerations apply in surgical planning [1–5]. Here we will explore results for EK after PK, surgical variations, and an algorithm for procedure choice.
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