Pk-Smart: Penetrating Keratoplasty With Sutureless Membrane Artificial Endothelial Replacement Technique. Report Of The First Three Clinical Cases.
Published 2026 - 44th Congress of the ESCRS
Reference: CC03.04 | Type: Case Report | DOI: 10.82333/yetz-f206
Authors: A/Prof. Luigi Fontana* 1 , A/Prof. Vito Romano 2 , Dr Natalie Di Geronimo 3 , A/Prof. Piera Versura 1 , A/Prof. Maurizio Mete 1 , A/Prof. Antonio Moramarco 4
1IRCCS Azienda Ospedaliero-Universitaria di Bologna,Bologna,Italy;Ophthalmology Unit, Dipartimento di Scienze Mediche e Chirurgiche,Alma Mater Studiorum University of Bologna,Bologna,Italy, 2Eye Unit, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health,University of Brescia,Brescia,Italy, 3IRCCS Azienda Ospedaliero-Universitaria di Bologna,Bologna,Italy, 4IRCCS Azienda Ospedaliero-Universitaria di Bologna,Bologna,Italy;Ophthalmology Unit, Dipartimento di Scienze Mediche e Chirurgiche,Alma Mater Studiorum University of Bologna,Bologna,Italy;Ophthalmology Unit,Santa Maria delle Croci Hospital, Ravenna,Ravenna,Italy
Purpose
To describe a novel sutureless corneal pocket technique that allows for simultaneous implantation of the EndoArt (EndoArt, EyeYon Medical, Israel) and penetrating keratoplasty (PK) in high-risk eyes for graft failure.
Setting
IRCCS Azienda Ospedaliero-Universitaria di Bologna, Ophthalmology Unit.
Report of case
Patient 1 had a history of multiple retinal detachments, two previous failed endothelial keratoplasties, and severe bullous keratopathy with stromal opacity, with a CDVA limited to light perception. Patient 2 had undergone multiple penetrating and endothelial keratoplasties following a primary diagnosis of keratoconus and presented with a CDVA of hand motion. Patient 3 had undergone multiple penetrating keratoplasty for endothelial decompensation secondary to a complicated cataract surgery requiring anterior vitrectomy and secondary intraocular lens implantation. The implant was positioned within a stromal lamellar pocket of the donor cornea before graft transplantation, without the need for transcorneal sutures or postoperative gas tamponade. The primary outcome measures included corrected distance visual acuity (CDVA), graft clarity, central corneal thickness (CCT), and device adherence. At 6 months, all corneal grafts were clear with complete EndoArt adhesion. The postoperative CDVA improved to HM, 20/400, and 20/100, respectively, while corneal pachymetry improved from 803 µm, 975 µm and 761 to 578 µm, 587 µm and 548 µm respectively. No postoperative complication was observed, including implant detachment requiring rebubbling.
Conclusion/Take home message
The PK-SMART technique ensures immediate mechanical stability of the EndoArt device in PK while addressing the stromal opacities, without recourse to transcorneal sutures or gas tamponade. Corneal clarity was restored in all our patients with quantifiable improvement of visual function. This combined approach simultaneously treats stromal opacity and endothelial dysfunction, expanding the applicability of artificial endothelial membranes to complex eyes previously deemed unsuitable for standalone implantation.