Deep Lamellar Endothelial Keratoplasty A new surgical cure for bullous keratopathy following cataract surgery.

Corneal edema after cataract surgery is sometimes unavoidable and occurs frequently after phacoemulsification in patients with Fuchs’ endothelial dystrophy or other preoperative conditions associated with marginal endothelial function. If significant corneal edema persists for 6 or more weeks after cataract surgery, then visual improvement may only be possible through surgical endothelial replacement. For the past 100 years, the only option for endothelial replacement surgery was full-thickness penetrating keratoplasty (PKP). Although the surgical technique for PKP has been greatly refined, visual rehabilitation after the procedure is still plagued by numerous problems (Table 1). In addition, the vertical stromal wound of PKP is inherently weak and subject to rupture from mild, blunt trauma, even years after the original surgery. These liabilities of PKP call for another, more selective means of surgical endothelial replacement. In 1993, Ko et al presented a technique of replacing the