Cornea Research Foundation of America, Indianapolis, Indiana 46260; email:
University Hospitals Eye Institute and Department of Ophthalmology and Visual Sciences, Case Western Reserve University, Cleveland, Ohio 44106; email:
Annu Rev Vis Sci. 2017 Sep 15;3:69-90. doi: 10.1146/annurev-vision-102016-061400. Epub 2017 Jul 11.
Endothelial keratoplasty (EK) has revolutionized treatment of corneal endothelial dysfunction. Compared with penetrating keratoplasty (PK), EK provides faster and more reliable visual rehabilitation while maintaining the eye's structural integrity. The number of EK procedures is growing annually and surpassed PK in the United States in 2012. The most widely used iteration, Descemet stripping endothelial keratoplasty (DSEK), implants healthy donor endothelium, Descemet membrane, and posterior stroma. Descemet membrane endothelial keratoplasty (DMEK) eliminates the donor stromal layer. Although more surgically challenging than DSEK, DMEK provides even faster visual rehabilitation and reduced risk of immunologic rejection, so its use is growing. Potential future alternatives to EK that could help address the unmet demand for donor corneas include removing central guttae and regenerating a central endothelial cell layer from healthy peripheral cells in patients with Fuchs' dystrophy or injecting cultured human corneal endothelial cells to rehabilitate eyes without residual healthy endothelium.
内皮角膜移植术（EK）彻底改变了角膜内皮功能障碍的治疗方法。与穿透性角膜移植术（PK）相比，EK 提供了更快、更可靠的视觉康复效果，同时保持了眼睛的结构完整性。EK 手术的数量逐年增加，在美国，EK 手术于 2012 年超过了 PK 手术。最广泛应用的迭代技术是撕囊的内皮角膜移植术（DSEK），它植入健康供体的内皮细胞、Descemet 膜和后基质。Descemet 膜内皮角膜移植术（DMEK）则去除了供体的基质层。尽管 DMEK 比 DSEK 更具挑战性，但它提供了更快的视觉康复效果，免疫排斥反应的风险更低，因此其应用正在增加。未来可能替代 EK 的技术，包括从患有 Fuchs 营养不良症的患者的健康周边细胞中去除中央基质层并再生中央内皮细胞层，或注射培养的人角膜内皮细胞来康复没有剩余健康内皮细胞的眼睛，以帮助解决对供体角膜的未满足需求。
