Endothelial Keratoplasty: Current State of the Art

Endothelial keratoplasty (EK) has become the predominant form of corneal transplantation because it provides tremendous advantages over penetrating keratoplasty (PK) for treatment of endothelial decompensation, including faster visual recovery, minimal refractive change, and lower risk of immunologic rejection. Postoperative management of EK is more straightforward than with full-thickness grafts. Most importantly, EK essentially eliminates the biggest safety concerns with PK, the risk of loss of vision because of intraoperative suprachoroidal hemorrhage or postoperative wound rupture from minor trauma. EK surgical technique variations have been developed to address cases with challenging ocular comorbidities. This chapter discusses the indications for EK, methods of donor preparation, techniques for preforming EK, and surgical challenges.