Eyeworld

World view Corneal lamellar surgical procedures I t was not so long ago when the greatest debates in corneal surgery were over issues of suture technique, i.e., use of interrupted sutures versus running sutures for full thick- ness penetrating keratoplasty (PK) surgery. Over the last decade, corneal transplant surgery has experienced a renaissance due to improved instrumentation, advancements in lamellar sur- gery techniques, and availability of the femtosec- ond laser to create custom corneal wound shapes. This has been an exciting time for ophthalmol- ogists and cornea specialists to be able to offer their patients truly specialized surgical care where the diseased cornea can be specifically targeted for removal and replacement. In 2013, the Eye Bank Association of America eye banks distributed tissue for 36,998 PKs (compared to 45,821 in 2005, a decrease of 19%), 27,298 endothelial keratoplasties (compared to 1,429 in 2005, a 19-fold increase), and 2,009 anterior lamellar procedures (compared to 869 in 2005, more than a 2-fold increase). In this issue of EyeWorld, Mohammed Anwar, MD, Thomas John, MD, and Francis Price, MD, discuss the advantages and disadvantages of deep anterior lamellar keratoplasty (DALK), where the anterior corneal pathology is removed leaving only Descemet's membrane. Surgical pearls and potential complications and management are also discussed. For patients with endo- thelial disease, there is the option of the Descemet's membrane endothelial keratoplasty (DMEK) approach or the easier-to-perform Descemet's stripping automated endothelial keratoplasty (DSAEK) technique. Massimo Busin, MD, Kristiana Neff, MD, and Neda Shamie, MD, review the history of how the DSAEK technique was developed, the relevance of donor tissue thickness, and indications for DSAEK versus DMEK. Mark Gorovoy, MD, Francis Price, MD, Mark Terry, MD, and Isabel Dapena, MD, PhD, comment on the benefits and challenges of DMEK, insertion techniques, and indications for DMEK over DSAEK. While fewer PKs are being performed, there is still a role for the procedure in corneal practice. Barry Lee, MD, Mark Mannis, MD, and Christopher Rapuano, MD, discuss indications for PK surgery, challeng- es with the procedure, issues regarding graft survival, and what the future holds. We hope you enjoy this issue of EyeWorld. Thank you to all the physicians above for taking the time to share their expertise. EW Clara Chan, MD, FRCSC, FACS cornea editor The official publication of the American Society of Cataract & Refractive Surgery A S C R S April 2015 Volume 20 • No. 4 Publisher Donald R. Long don@eyeworld.org Editorial Editor Erin L. Boyle erin@eyeworld.org Managing Editor Stacy Majewicz stacy@eyeworld.org Staff Writer Ellen Stodola ellen@eyeworld.org Staff Writer Lauren Lipuma lauren@eyeworld.org Production Graphic Designer Julio Guerrero julio@eyeworld.org Graphic Design Assistant Susan Steury susan@eyeworld.org Production Manager Cathy Stern cathy@eyeworld.org 703-383-5702 Production Assistant Carly Peterson carly@eyeworld.org Contributing Writers Vanessa Caceres Lakeland, Fla. Michelle Dalton Reading, Pa. Matt Young Malaysia Enette Ngoei Dublin Rich Daly Arlington, Va. Senior Contributing Writer Maxine Lipner Nyack, N.Y. 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