PRE-DESCEMET’S ENDOTHELIAL KERATOPLASTY (PDEK): AN ALTERNATIVE APPROACH IN ENDOTHELIAL KERATOPLASTY

To evaluate Pre-Descemet's Endothelial Keratoplasty (PDEK) as an effective alternative to
the widely-used Descemet Membrane Endothelial Keratoplasty (DMEK) for patients
undergoing endothelial keratoplasty.

This study includes cases of classic endothelial decompensation in Fuchs’ dystrophy and
instances of endothelial decompensation post-penetrating keratoplasty (differential
rejection).

Donor grafts, selected with a minimum cell density of 2500 cells/mm2, were utilized
regardless of donor age. Using a 27G cannula, the Dua-Descemet complex was gently
separated by trypan blue injection through pressure and counterpressure techniques to form
a Type 1 bubble. The graft was not marked and was cut to an 8 mm diameter before loading
into a Janach-type cannula. Recipient preparation involved a broad descemetorhexis,
followed by air-bubble-assisted graft insertion.

Postoperative outcomes indicated rapid corneal clearance within days and a reduction in
superficial opacities in cases with advanced Fuchs dystrophy. PDEK demonstrated several
advantages: efficient graft preparation, minimized cell loss, suitability for grafts from donors
of any age, reduced preparation costs, and no need for graft marking due to the natural
elasticity of Dua’s layer, which helps prevent orientation errors.

PDEK offers a faster learning curve and lower procedural costs compared to Descemet
Stripping Automated Endothelial Keratoplasty (DSAEK). Future studies will determine
whether incorporating Dua’s layer into the graft may reduce rejection rates compared to the
DMEK procedure.

No financial disclosure.