Pre-Descemet’s Endothelial Keratoplasty



Pre-Descemet’s endothelial keratoplasty (PDEK) is a technique of endothelial keratoplasty (EK) that was described by one of the authors (Prof. Amar Agarwal) and Prof. Harminder Dua where the Pre-Descemet’s layer (PDL) is also transplanted along with the Descemet’s membrane (DM) and endothelium [1]. It thus differs from Descemet’s membrane endothelial keratoplasty (DMEK) [2, 3] in which only the Descemet’s membrane and endothelium are transferred. It also differs from Descemet’s stripping automated endothelial keratoplasty (DSAEK) [4] and ultra-thin DSAEK (UT-DSAEK) [5, 6] in not transferring stroma. The PDL has been described as a cellular, measuring about 10–15 μm, and composed of 10–15 lamellae made of type I collagen bundles arranged in transverse, longitudinal and oblique directions (Fig. 12.1) [7].


Corneal Dystrophy Bullous Keratopathy Endothelial Keratoplasty Pseudophakic Bullous Keratopathy Host Stroma 
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  1. 1.
    Agarwal A, Dua HS, Narang P, Kumar DA, Agarwal A, Jacob S, Agarwal A, Gupta A. Pre-Descemet’s endothelial keratoplasty (PDEK). Br J Ophthalmol. 2014;98(9):1181–5.CrossRefPubMedGoogle Scholar
  2. 2.
    Dapena I, Ham L, Melles GRJ. Endothelial keratoplasty: DSEK/DSAEK or DMEK – the thinner the better? Curr Opin Ophthalmol. 2009;20:299–307.CrossRefPubMedGoogle Scholar
  3. 3.
    Dapena I, Moutsouris K, Droutsas K, et al. Standardized “no-touch” technique for Descemet membrane endothelial keratoplasty. Arch Ophthalmol. 2011;129:88–94.CrossRefPubMedGoogle Scholar
  4. 4.
    Gorovoy MS. Descemet-stripping automated endothelial keratoplasty. Cornea. 2006;25:886–9.CrossRefPubMedGoogle Scholar
  5. 5.
    Busin M, Madi S, Santorum P, Scorcia V, Beltz J. Ultrathin descemet’s stripping automated endothelial keratoplasty with the microkeratome double-pass technique: two-year outcomes. Ophthalmology. 2013;120(6):1186–94.CrossRefPubMedGoogle Scholar
  6. 6.
    Busin M, Albé E. Does thickness matter: ultrathin Descemet stripping automated endothelial keratoplasty. Curr Opin Ophthalmol. 2014;25(4):312–8.CrossRefPubMedGoogle Scholar
  7. 7.
    Dua HS, Faraj LA, Said DG, Gray T, Lowe J. Human corneal anatomy redefined: a novel pre-Descemet’s layer (Dua’s layer). Ophthalmology. 2013;120(9):1778–85.CrossRefPubMedGoogle Scholar
  8. 8.
    Ashton Acton. Epithelial cells—Advances in research and application: 2013 edition. Scholarly Editions. Chapter 4: Endothelial cells, Pg 368Google Scholar
  9. 9.
    Bennett A, Mahmoud S, Drury D, Dwight CH, McCulley J, Matthew PW, Vinod MV. Impact of donor age on corneal endothelium-descemet membrane layer scroll formation. Eye Contact Lens: Sci Clin Pract. 2015;41(Issue 4):236–9.CrossRefGoogle Scholar
  10. 10.
    Kobayashi A, Yokogawa H, Yamazaki N, Masaki T, Sugiyama K. Endothelial keratoplasty with infant donor tissue. Clin Ophthalmol. 2014;8:1827–30.CrossRefPubMedPubMedCentralGoogle Scholar
  11. 11.
    Agarwal A, Agarwal A, Narang P, Kumar DA, Jacob S. Pre-descemet endothelial keratoplasty with infant donor corneas: a prospective analysis. Cornea. 2015;34(8):859–65.CrossRefPubMedGoogle Scholar
  12. 12.
    Agarwal A. Trocar anterior chamber maintainer facilitates ocular surgeries. Ocular Surgery News U.S. Edition, July 10, 2015Google Scholar
  13. 13.
    Jacob S, Agarwal A, Agarwal A, Narasimhan S, Kumar DA, Sivagnanam S. Endoilluminator-assisted transcorneal illumination for Descemet membrane endothelial keratoplasty: enhanced intraoperative visualization of the graft in corneal decompensation secondary to pseudophakic bullous keratopathy. J Cataract Refract Surg. 2014;40(8):1332–6.CrossRefPubMedGoogle Scholar
  14. 14.
    Burkhart ZN, Feng MT, Price MO, Price FW. Handheld slit beam techniques to facilitate DMEK and DALK. Cornea. 2013;32(5):722–4.CrossRefPubMedGoogle Scholar
  15. 15.
    Veldman PB, Dye PK, Holiman JD, Mayko ZM, Sáles CS, Straiko MD, Stoeger CG, Terry MA. Stamping an S on DMEK Donor tissue to prevent upside-down grafts: laboratory validation and detailed preparation technique description. Cornea. 2015 Sep;34(9):1175-8.Google Scholar
  16. 16.
    Cost B, Goshe JM, Srivastava S, Ehlers JP.Intraoperative Optical Coherence Tomography-Assisted Descemet Membrane Endothelial Keratoplasty in the DISCOVER Study. Am J Ophthalmol. 2015 Sep;160(3):430-7.Google Scholar
  17. 17.
    Saad A, Guilbert E, Grise-Dulac A, Sabatier P, Intraoperative GD. Intraoperative OCT-assisted DMEK: 14 consecutive cases. Cornea. 2015;34(7):802–7.CrossRefPubMedGoogle Scholar

Copyright information

© Springer India 2016

Authors and Affiliations

  1. 1.Dr. Agarwal’s Refractive and Cornea FoundationDr. Agarwal’s Group of Eye HospitalsChennaiIndia
  2. 2.Dr. Agarwal’s Eye HospitalChennaiIndia

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