Penetrating and Endothelial Keratoplasty: An Overview

  • Prafulla K. Maharana
  • Rajesh Pattebahadur
  • Namrata Sharma


Corneal allograft is one of the most successful forms of solid organ transplantation. Normally, HLA typing and systemic immunosuppressive drugs are not utilized, yet 90 % of corneal allografts survive [1, 2]. The better acceptance of corneal allografts compared to other categories of allografts is due to the unique immunological property of cornea, coined by Medawar as immune privilege. This immune privilege is abolished in conditions such as inflammation, neovascularization, or trauma to cornea.


Anterior Chamber Corneal Graft Immune Privilege Anterior Segment Optical Coherence Tomography Deep Anterior Lamellar Keratoplasty 
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  1. 1.
    Niederkorn JY, Larkin DF. Immune privilege of corneal allografts. Ocul Immunol Inflamm. 2010;18:162–71.CrossRefPubMedPubMedCentralGoogle Scholar
  2. 2.
    Streilein JW. Ocular immune privilege: therapeutic opportunities from an experiment of nature. Nat Rev Immunol. 2003;3(11):879–89.CrossRefPubMedGoogle Scholar
  3. 3.
    Albuquerque RJ, Hayashi T, Cho WG, et al. Alternatively spliced vascular endothelial growth factor receptor-2 is an essential endogenous inhibitor of lymphatic vessel growth. Nat Med. 2009;15(9):1023–30.CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    Niederkorn JY. Anterior chamber-associated immune deviation and its impact on corneal allograft survival. Curr Opin Organ Transplant. 2006;11:360–5.CrossRefGoogle Scholar
  5. 5.
    Krachmer J, Mannis M, Holland E. Keratoplasty, part XI. Cornea. 3rd ed. USA: Elsevier, 2011.Google Scholar
  6. 6.
    Arenas E, Esquenazi S, Anwar M, Terry M. Lamellar corneal transplantation. Surv Ophthalmol. 2012;57(6):510–29.CrossRefPubMedGoogle Scholar
  7. 7.
    Tan DT, Anshu A. Anterior lamellar keratoplasty: ‘Back to the Future’ – a review. Clin Experiment Ophthalmol. 2010;38(2):118–27.PubMedGoogle Scholar
  8. 8.
    Maharana PK, Agarwal K, Jhanji V, Vajpayee RB. Deep anterior lamellar keratoplasty for keratoconus: a review. Eye Contact Lens. 2014;40(6):382–9.CrossRefPubMedGoogle Scholar
  9. 9.
    Vajpayee RB, Vasudendra N, Titiyal JS, Tandon R, Sharma N, Sinha R. Automated lamellar therapeutic keratoplasty (ALTK) in the treatment of anterior to mid-stromal corneal pathologies. Acta Ophthalmol Scand. 2006;84(6):771–3.CrossRefPubMedGoogle Scholar
  10. 10.
    Archila EA. Deep lamellar keratoplasty dissection of host tissue with intra-stromal air injection. Cornea. 1984;3:217–8.PubMedGoogle Scholar
  11. 11.
    Anwar M, Teichmann KD. Deep lamellar keratoplasty; surgical techniques for anterior lamellar keratoplasty with and without baring of Descemet’s membrane. Cornea. 2002;21:374–83.CrossRefPubMedGoogle Scholar
  12. 12.
    Jhanji V, Beltz J, Sharma N, Graue E, Vajpayee RB. “Double bubble” deep anterior lamellar keratoplasty for management of corneal stromal pathologies. Int Ophthalmol. 2011;31:257–62.CrossRefPubMedGoogle Scholar
  13. 13.
    Melles GR, Remeijer L, Geerards AJ, Beekhuis WH. A quick surgical technique for deep, anterior lamellar keratoplasty using visco-dissection. Cornea. 2000;19:427–32.CrossRefPubMedGoogle Scholar
  14. 14.
    Sugita J, Kondo J. Deep lamellar keratoplasty with complete removal of pathological stroma for vision improvement. Br J Ophthalmol. 1997;81:184–8.CrossRefPubMedPubMedCentralGoogle Scholar
  15. 15.
    Buzzonetti L, Laborante A, Petrocelli G. Standardized big-bubble technique in deep anterior lamellar keratoplasty assisted by femtosecond laser. J Cataract Refract Surg. 2010;36:1631–6.CrossRefPubMedGoogle Scholar
  16. 16.
    Vajpayee RB, Maharana PK, Sharma N, Agarwal T, Jhanji V. Diamond knife-assisted deep anterior lamellar keratoplasty to manage keratoconus. J Cataract Refract Surg. 2014;40:276–82.CrossRefPubMedGoogle Scholar
  17. 17.
    Anshu A, Price MO, Tan DT, Price Jr FW. Endothelial keratoplasty: a revolution in evolution. Surv Ophthalmol. 2012;57(3):236–52.CrossRefPubMedGoogle Scholar
  18. 18.
    Lee WB, Jacobs DS, Musch DC, et al. Descemet’s stripping endothelial keratoplasty: safety and outcomes: a report by the American Academy of Ophthalmology. Ophthalmology. 2009;116:18–30.Google Scholar
  19. 19.
    Hsu M, Hereth WL, Moshirfar M. Double-pass microkeratome technique for ultra-thin graft preparation in Descemet’s stripping automated endothelial keratoplasty. Clin Ophthalmol. 2012;6:425–32.PubMedPubMedCentralGoogle Scholar
  20. 20.
    Price Jr FW, Price MO. Descemet’s stripping with endothelial keratoplasty in 50 eyes: a refractive neutral corneal transplant. J Refract Surg. 2005;21:339–45.PubMedGoogle Scholar
  21. 21.
    Ang M, Wilkins MR, Mehta JS, Tan D. Descemet membrane endothelial keratoplasty. Br J Ophthalmol. 2016;100(1):15–21.Google Scholar
  22. 22.
    Tourtas T, Laaser K, Bachmann BO, Cursiefen C, Kruse FE. Descemet membrane endothelial keratoplasty versus descemet stripping automated endothelial keratoplasty. Am J Ophthalmol. 2012;153(6):1082–90.CrossRefPubMedGoogle Scholar
  23. 23.
    Güell JL, El Husseiny MA, Manero F, Gris O, Elies D. Historical review and update of surgical treatment for corneal endothelial diseases. Ophthalmol Ther. 2014;3(1-2):1–15.Google Scholar
  24. 24.
    Ple-Plakon PA, Shtein RM. Trends in corneal transplantation: indications and techniques. Curr Opin Ophthalmol. 2014;25(4):300–5.CrossRefPubMedGoogle Scholar
  25. 25.
    Mozayan E, Lee JK. Update on astigmatism management. Curr Opin Ophthalmol. 2014;25(4):286–90.CrossRefPubMedGoogle Scholar
  26. 26.
    Qazi Y, Hamrah P. Corneal allograft rejection: immunopathogenesis to therapeutics. J Clin Cell Immunol. 2013;2013(Suppl 9). pii: 6.Google Scholar
  27. 27.
    Young AL, Kam KW, Jhanji V, Cheng LL, Rao SK. A new era in corneal transplantation: paradigm shift and evolution of techniques. Hong Kong Med J. 2012;18(6):509–16.PubMedGoogle Scholar
  28. 28.
    Managing corneal blindness. NPCB India News Letter, April-June 2012. Accessed on 25/06/2016.

Copyright information

© Springer India 2016

Authors and Affiliations

  • Prafulla K. Maharana
    • 1
  • Rajesh Pattebahadur
    • 1
  • Namrata Sharma
    • 2
  1. 1.Department of OphthalmologyAll India Institute of Medical SciencesBhopalIndia
  2. 2.Cornea and Refractive Surgery ServicesDr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical SciencesNew DelhiIndia

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