POSSIBLE SURGICAL APPROACHES IN CORNEAL ENDOTHELIAL FAILURE: A CRITICAL ANALYSIS OF THE CURRENT LITERATURE

• DOI: 10.22533/at.ed.1593502307076

• Palavras-chave: Corneal Endothelial Failure, Automated Endothelial Keratoplasty with Descemet Stripping (DSAEK), Descemet's Membrane Endothelial Keratoplasty (DMEK), Deep Anterior Lamellar Keratoplasty (DALK).

• Keywords: Corneal Endothelial Failure, Automated Endothelial Keratoplasty with Descemet Stripping (DSAEK), Descemet's Membrane Endothelial Keratoplasty (DMEK), Deep Anterior Lamellar Keratoplasty (DALK).

• Abstract:

  Objective: To identify, through the current literature, the main surgical interventions for the treatment of corneal endothelial failure, their practical applications, technical aspects, indications and contraindications, as well as the challenges and limitations of each procedure. Methodology: Literature review carried out from April to May 2023, with searches in the Scielo and PubMed databases, where 370 articles were found and 15 were selected for analysis. Results: Data demonstrated a preference for Descemet's Automated Endothelial Keratoplasty with Stripping (DSAEK) or Descemet's Membrane Endothelial Keratoplasty (DMEK) compared to Deep Anterior Lamellar Keratoplasty (DALK). DSAEK showed a greater association with immunological rejection, as well as a longer period until full postoperative recovery and the need for more training to be performed properly, but showed better rehabilitation of early visual acuity. On the other hand, DMEK proved to be a more complex procedure for performing and preparing the graft, however, it presented better visual and refractive results, with less graft rejection, provided that patients were properly oriented regarding the signs of rejection and risk factors.
  Final considerations: The different types of studies analyzed indicate that, in order to succeed in transplanting healthy cells, the choice of technique must be based on specific criteria related to the expertise and functional capacity of each service and location. Therefore, it is necessary to carry out comparative studies in controlled situations in order to obtain detailed data that allow a better elucidation of the ideal indications for each method.