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Transitioning from PK to DMEK in a Public Hospital in Southern Brazil: First Series of 24 Consecutive Cases
Diane Marinho; Sérgio Kwitko; Bruno Schneider de Araujo; Felipe Pigozzi Cabral; Melissa Dal Pizzol, and Tiago Lansini
Endothelial keratoplasty (EK) is probably the most exciting development in corneal transplantation since the introduction of monofilament sutures and the operating microscope. Since the advent of penetrating keratoplasty surgery more than 100 years ago, we have recognized the undesirable postoperative consequences of penetrating corneal surgery.1 These adverse sequelae include increased high astigmatism, unpredictable refractive outcomes, prolonged visual rehabilitation and vulnerability to trauma. In cases of corneal edema from endothelial dysfunction, ophthalmologists have conceptualized the theoretical benefits of selectively transplanting only the posterior cornea with healthy endothelium. In 1950, Barraquer proposed performing lamellar transplantation of the posterior cornea in cases of corneal edema. He described a procedure in which he trephined just the posterior central cornea after manually dissecting a rectangular flap similar to that used in Laser-Assisted In Situ Keratomileusis (LASIK). Ultimately a corresponding round lenticule of donor posterior corneal tissue containing healthy endothelium was transplanted into this opening.2 Despite the outstanding idea, the results of this technique were never described and the procedure was forgotten for some decades.