The power of a bubble: Descemet's stripping endothelial keratoplasty (DSEK) and rebubbling

The history of lamellar keratoplasty (LK) surgery spans several decades, and its advantages have long been known. However, new strategies and technology have promoted a resurgence of LK in visual rehabilitation. One specific type of LK is endothelial transplantation, in all its variations. This is a form of corneal transplantation in which a donor posterior corneal button, including corneal endothelium, Descemet's membrane with, or more recently without, posterior corneal stroma (DSEK or Descemet's membrane endothelial keratoplasty, DMEK respectively) is used for selective replacement of the diseased corneal endothelium.1–5 Endothelial keratoplasty has numerous advantages over penetrating keratoplasty for indications related to endothelial dysfunction. These include faster visual improvement, retention of the structural integrity of the eye, preservation of corneal innervation and lack of suture-related complications such as infection, dehiscence and induced astigmatism.3 4 6 7 The incidence of endothelial rejection, too, is lower compared with penetrating keratoplasty.8 9 Despite a steep learning curve, DSEK is a relatively easier surgical procedure. Although evidence shows that endothelial transplantation including DSEK is a safe and effective treatment for corneal endothelial disease, there are a range of complications associated with the procedure. The most common complications of DSEK and Descemet's stripping and automated endothelial keratoplasty (DSAEK) quoted in the literature are graft detachments and dislocations, primary graft failure and endothelial rejection. The rate of these complications varies, and the …