Visual outcomes in corneal transplantation

摘要: ▸  Related article: 10.1136/bjophthalmol-2011-301349 Penetrating keratoplasty (PK) or full thickness corneal transplantation has enjoyed great success for over a century.1 ,2 Dramatic visual improvement can be achieved by this procedure but it is not without problems. Immune mediated rejection of the graft requiring long term topical systemic immune-suppression, unpredictable degrees astigmatism and structurally weak eye susceptible to wound dehiscence following trivial trauma have remained major issues years. Lamellar keratoplasty, wherein anterior affected layers cornea are replaced transparent donor tissue equivalent thickness, had roller-coaster ride largely due interface haze scarring with consequent reduction in quality vision. Recent advances surgical techniques propelled operation its highest crest. It now possible separate Descemet's membrane endothelium from posterior stroma, allowing replacement entire stroma thus eliminating risk failure secondary endothelial making virtually an extra-ocular procedure. Problems astigmatism, sutures structural weakness however remain. Similarly affections, replace diseased through small entry wound. This does alter requires minimal suturing weaken like penetrating graft. The most popular procedures stripping (DSEK) recipient together 100–150 microns …