EC Ophthalmology

Review Article Volume 15 Issue 5 - 2024

Keratoplasty: The Progress from Penetrating to Cellular Transplants - Short Review

Martyna Dydyk1, Ewa Sikorska2, Piotr Sikorski1, Robert Tomaszewski1 and Dorota Kopacz3*

1Student Research Club at the Department of Ophthalmology, Infant Jesus Teaching Hospital, Medical University of Warsaw, Warsaw, Poland
2Chair and Department of Experimental and Clinical Physiology, Center for Preclinical Research, Medical University of Warsaw, Warsaw, Poland
3Department of Ophthalmology, Infant Jesus Teaching Hospital, Medical University of Warsaw, Warsaw, Poland

*Corresponding Author: Dorota Kopacz, Department of Ophthalmology, Infant Jesus Teaching Hospital, Medical University of Warsaw, Warsaw, Poland.
Received: March 11, 2024; Published: April 26, 2024



The cornea is a transparent membrane that acts as a protective barrier to the eye and refracts light. Corneal disorders (diseases, dystrophies, degenerations, injuries) can lead to a loss of translucency. Corneal opacity is a one of major causes of blindness, affecting approximately 6 million people worldwide. For patients with corneal blindness, the only method of regaining vision is corneal transplantation (keratoplasty). Keratoplasty has evolved to include various methods such as penetrating keratoplasty (PK), anterior lamellar keratoplasty (ALK), and posterior/endothelial keratoplasty (PK/EK). Lamellar keratoplasty has gained popularity due to its improved outcomes and reduced risks compared to penetrating keratoplasty. Modern keratoplasty benefits from additional tools like optical coherence tomography and femtosecond lasers, which enhance surgical precision and decision-making. Future for corneal disease treatment assumes partial EK, Descemet membrane endothelial transfer, descemetorhexis stripping without endothelial keratoplasty, using ROCK inhibitors, cell therapy, tissue engineering grafts, stem cells and combination of all of them. Further studies are necessary to confirm advantages of those trends.

Keywords: Cornea; Corneal Transplantation; Keratoplasty; Corneal Grafting

  1. Pradeep T., et al. “Histology, Eye”. StatPearls. StatPearls Publishing. Copyright © 2022, StatPearls Publishing LLC. (2022).
  2. Young AL., et al. “A new era in corneal transplantation: paradigm shift and evolution of techniques”. Hong Kong Medical Journal 6 (2012): 509-518.
  3. World Health Organization. “World report on vision 2019” (2019).
  4. Lee SY and Mesfin FB. “Blindness”. StatPearls. StatPearls Publishing. Copyright © 2022, StatPearls Publishing LLC. (2022).
  5. Tan DT., et al. “Corneal transplantation”. Lancet 9827 (2012): 1749-1761.
  6. Pekel E and Pekel G. “Publication trends in corneal transplantation: a bibliometric analysis”. BMC Ophthalmology1 (2016): 194.
  7. Kim MH., et al. “A retrospective contrarateral study comparing deep anterior lamellar keratoplasty with penetrating keratoplasty”. Cornea 4 (2013): 385-389.
  8. Ple-Plakon PA and Shtein RM. “Trends in corneal transplantation: indications and techniques”. Current Opinion in Ophthalmology 4 (2014): 300-305.
  9. Kitzman AS., et al. “Comparison of outcomes of penetrating keratoplasty versus Descemet's stripping automated endothelial keratoplasty for penetrating keratoplasty graft failure due to corneal oedema”. International Ophthalmology 1 (2012): 15-23.
  10. Crawford AZ., et al. “A brief history of corneal transplantation: From ancient to modern”. Oman Journal of Ophthalmology 1 (2013): S12-S17.
  11. Zhang J., et al. “The rapid transformation of transplantation for corneal endothelial diseases: an evolution from penetrating to lamellar to cellular transplants”. Asia-Pacific Journal of Ophthalmology 6 (2019): 441-447.
  12. Qureshi S and Dohlman TH. “Penetrating keratoplasty: indications and graft survival by geographic region”. Seminars in Ophthalmology 1 (2023): 31-43.
  13. Thompson Jr., et al. “Long-term graft survival after penetrating keratoplasty”. Ophthalmology7 (2003): 1396-1402.
  14. Crawford AZ., et al. “Corneal transplantation in New Zealand 200 to 2009”. Cornea 3 (2018): 290-295.
  15. Fan JC., et al. “Corticosteroid-induced intraocular pressure elevation in keratoconus is common following uncomplicated penetrating keratoplasty”. Eye 11 (2009): 2056-2062.
  16. Abudou M., et al. “Immunosuppressants for the prophylaxis of corneal graft rejection after penetrating keratoplasty”. Cochrane Database of Systematic Reviews 8 (2015): Cd007603.
  17. Singh R., et al. “Corneal transplantation in the modern era”. Indian Journal of Medical Research 1 (2019): 7-22.
  18. Singh NP., et al. “Lamellar keratoplasty techniques”. Indian Journal of Ophthalmology 9 (2018): 1239-1250.
  19. Kaufman HE., et al. “Human fibrin tissue adhesive for sutureless lamellar keratoplasty and scleral patch adhesion: a pilot study”. Ophthalmology11 (2003): 2168-2172.
  20. Moshirfar M., et al. “Corneal Endothelial Transplantation”. StatPearls (2022).
  21. Hos D., et al. “Immune reactions after modern lamellar (DALK, DSAEK, DMEK) versus conventional penetrating corneal transplantation”. Progress in Retinal and Eye Research 73 (2019): 100768.
  22. Maghsoudlou P., et al. “Cornea Transplantation”. StatPearls. StatPearls Publishing. Copyright © 2022, StatPearls Publishing LLC. (2022).
  23. Vajpayee RB. “Deep Anterior lamellar Keratoplasty: In search of Holy Grail!” Journal of Current Ophthalmology 4 (2017): 233-234.
  24. Luengo-Gimeno F., et al. “Evolution of deep anterior lamellar keratoplasty (DALK)”. The Ocular Surface 2 (2011): 98-110.
  25. Shimazaki J., et al. “Randomized clinical trial of deep lamellar keratoplasty vs penetrating keratoplasty”. American Journal of Ophthalmology 2 (2002): 159-165.
  26. Bauderie VM., et al. “Comparison of techniques used for removing the recipient stroma in anterior lamellar keratoplasty”. Archives of Ophthalmology 1 (2008): 31-37.
  27. Singh R., et al. “Corneal transplantation in the modern era”. Indian Journal of Medical Research 1 (2019): 7-22.
  28. Singh NP., et al. “Lamellar keratoplasty techniques”. Indian Journal of Ophthalmology 9 (2018): 1239-1250.
  29. van Dijk K., et al. “Midstromal isolated Bowman layer graft for reduction of advanced keratoconus: a technique to postpone penetrating or deep anterior lamellar keratoplasty”. JAMA Ophthalmology4 (2014): 495-501.
  30. van Dijk K., et al. “Bowman layer transplantation to reduce and stabilize progressive, advanced keratoconus”. Ophthalmology5 (2015): 909-917.
  31. van Dijk K., et al. “Midstromal isolated Bowman layer graft for reduction of advanced keratoconus: a technique to postpone penetrating or deep anterior lamellar keratoplasty”. JAMA Ophthalmology4 (2014): 495-501.
  32. Bahar I., et al. “Comparison of posterior lamellar keratoplasty techniques to penetrating keratoplasty”. Ophthalmology9 (2008): 1525-1533.
  33. Li S., et al. “Efficacy and safety of Descemet's membrane endothelial keratoplasty versus Descemet's stripping endothelial keratoplasty: A systematic review and meta-analysis”. PloS one12 (2017): e0182275-e0182275.
  34. Stuart AJ., et al. “Descemet's membrane endothelial keratoplasty (DMEK) versus Descemet's stripping automated endothelial keratoplasty (DSAEK) for corneal endothelial failure”. Cochrane Database of Systematic Reviews 6 (2018): Cd012097.
  35. Katz T., et al. “Prediction model of free flaps in microkeratome-assisted LASIK”. PLoS One9 (2021): e0255525.
  36. Dunker SL., et al. “Practice patterns of corneal transplantation in Europe: first report by the European Cornea and Cell Transplantation Registry”. Journal of Cataract and Refractive Surgery 7 (2021): 865-869.
  37. Tourabaly M., et al. “Influence of graft thickness and regularity on vision recovery after endothelial keratoplasty”. British Journal of Ophthalmology 9 (2020): 1317-1323.
  38. Bayyoud T., et al. “Outcomes after Descemet membrane endothelial keratoplasty over a period of 7 years at a tertiary referral center: endothelial cell density, central corneal thickness, and visual acuity”. Graefe's Archive for Clinical and Experimental Ophthalmology = Albrecht von Graefes Archiv fur Klinische und Experimentelle Ophthalmologie 7 (2021): 1907-1914.
  39. Nuzzi R., et al. “From DMEK to Corneal Endothelial Cell Therapy: Technical and Biological Aspects”. Journal of Ophthalmology (2018): 6482095.
  40. Chen S-Y and Terry MA. “Step-by-step Descemet's membrane endothelial keratoplasty surgery”. Taiwan Journal of Ophthalmology1 (2019): 18-26.
  41. Eisenbeisz HC., et al. “Descemet membrane endothelial keratoplasty and light adjustable lens triple procedure”. American Journal of Ophthalmology Case Reports 22 (2021): 101061.
  42. Chaurasia S., et al. “Descemet's membrane endothelial keratoplasty: clinical results of single versus triple procedures (combined with cataract surgery)”. Ophthalmology2 (2014): 454-458.

Dorota Kopacz., et al. "Keratoplasty: The Progress from Penetrating to Cellular Transplants - Short Review." EC Ophthalmology 15.5 (2024): 01-10.