BOOK REVIEW

Occasionally, a new technique is developed that forever changes the landscape of a particular subspecialty. For retinal surgery, it was vitrectomy. For cataract surgery, it was phacoemulsification. And for corneal surgery, it can be convincingly argued that Descemet’s stripping automated endothelial keratoplasty (DSAEK) serves that role. DSAEK offers the patient faster visual rehabilitation than penetrating keratoplasty, with limited astigmatism and postoperative complications. Within the 15 years since Gerrit Melles first developed posterior lamellar keratoplasty, DSAEK has come to account for nearly half of all corneal grafts performed in the US. When considered together, bullous keratopathy and Fuchs’ endothelial dystrophy currently form the largest indication for corneal transplantation.

Indeed, over the period 2005 to 2008, the Eye Bank Association of America reported a massive increase in the number of endothelial transplants from around 1,400 to over 17,000, while the number of penetrating keratoplasties has decreased from nearly 46,000 to less than 33,000 over the same period. This point has not been lost on the editors of a new text by Jaypee Highlights entitled “Descemet’s Stripping Automated Endothelial Keratoplasty: Different Strokes.” Drs D Cassidy, N Sharma, V Jhanji and R Vajpayee have compiled a thorough guide to the procedure.

The text is divided into five sections that proceed chronologically and with increasing complexity from beginning to end. Section 1, “Evolution, Indications, Preoperative Evaluation and Eye Banking” begins with the history of corneal transplantation, which started in 1905 when the Czech Eduard Zirm performed the world’s first successful human corneal transplant.

What this first section makes clear, however, is that despite the authors’ assertion that DSAEK is an “easy-toperform, safe, effective and reproducible technique,” the (contra)-indications are of crucial importance, and a detailed preoperative examination is essential.

Section 2, “Surgical Techniques and Modifications,” discusses the standard procedure, the instruments needed and the various modifications implemented in particular situations. Chapter 8 is a particularly interesting starting point for the surgeon interested in a proper explanation of the entire procedure. Surgical photographs illustrate every step, including donor preparation. The section continues with discussions of the hitch suture technique; sutureless DSAEK using the Busin Glide; the Tan EndoGlide technique; the Sheet Glide; and ultra-thin DSAEK, which might result in better visual outcomes than standard DSAEK.

Once the basic procedure and its common variants have been mastered, the reader can progress to Section 3, “DSAEK in Special Situations.” These include a DSAEK triple procedure as well as DSAEK in aphakic eyes, in eyes with intraoperative floppy iris syndrome (IFIS), in glaucomatous eyes, in paediatric eyes and in eyes that have suffered failed grafts.

Section 4, “Outcomes & Complications of DSAEK” describes what the surgeon can expect if the procedure has been performed correctly, as well as what to do when it hasn’t. Chapter 24 covers intraoperative complications such as perforation of the donor cornea by the microkeratome blade and iris prolapse through the corneoscleral tunnel. Chapter 25 covers the most common postoperative complication, early graft dislocation, among others.

The last section delineates the future of endothelial keratoplasty, including DMEK. This book is most appropriate for cornea fellows who are learning to perform DSAEK, as well as residents during their cornea rotation. General ophthalmologists, who might see patients with endothelial disease who need a referral to a cornea specialist or who present with postoperative complications, will also benefit from having access to this text.