Descemet's Stripping Without Endothelial Keratoplasty

Daniel Garcerant; Nino Hirnschall; Nicholas Toalster; Meidong Zhu; Li Wen; Gregory Moloney


Curr Opin Ophthalmol. 2019;30(4):275-285. 

In This Article


The transition from penetrating to lamellar keratoplasty has become established amongst corneal surgeons. We may now be taking our first steps beyond lamellar grafting into cell-based therapies. DWEK/DSO supplemented with topical Rho-kinase inhibitor is likely an early step on that journey. What is currently known is that the success of the procedure may relate to patient factors that remain poorly defined, and surgical factors that are increasingly well defined, with avoidance of stromal contact paramount. The safety and efficacy of supplementary ROCK inhibitor is the focus of current study with anecdotal reports of success now under scrutiny and early trial results encouraging. Both the cytoskeletal effects and the mitotic effects of ROCK inhibition seem to be lessened or even negated by cell–cell contact. This observation may be key to explaining why we have witnessed significant effects of these agents in the presence of an endothelial defect, but no resuscitation of low cell counts in situations of slow burning endothelial failure. Reports of the longevity of the procedure and health of subsequent grafts if required are necessary as the study of this technique continues.