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 patient undergoing endothelial keratoplasty

This study includes cases  of classic endothelial décompensation in Fuchs dystrophy and instance of endothelial décompensation post penetrating keratoplasty

Donor grafts , selected with a minimum cell density of 2500 cells/mm2  were utilized regardless of donor age .using a27 gauge cannula (, the Dua- descemet complex was gently separated by trypan blue injection through pressure and counter pressure techniques to create a bubble type 1.The graft is 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.

Post operative outcomes indicated swift corneal transparency within less one week and reduction of opacities.

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 DSAEK ( Descemet Strippng  Automated Endothelial Keratoplasty.

Future studies will determine whether incorporating Dua's layer  into the graft may reduce rejection rates compared to the DMEK procedure