%0 Journal Article
%T Posterior Lamellar Graft Preparation: A Prospective Review from an Eye Bank on Current and Future Aspects
%A Mohit Parekh
%A Gianni Salvalaio
%A Alessandro Ruzza
%A Davide Camposampiero
%A Carlo Griffoni
%A Alfonso Zampini
%A Diego Ponzin
%A Stefano Ferrari
%J Journal of Ophthalmology
%D 2013
%I Hindawi Publishing Corporation
%R 10.1155/2013/769860
%X Descemet membrane endothelial keratoplasty (DMEK) is a corneal surgical technique which selectively replaces the damaged posterior part of the cornea with a healthy donor graft retaining the rest of the tissue intact. There is a need to validate and standardize the donor tissue before grafting due to certain issues that can lead to consequences such as graft failure due to poor endothelial cell count, higher mortality, detachment of the graft, or increased surgical expenses, time, and effort. Thus, prospective potential surgeons and eye banks should now aim at developing new improved surgical techniques in order to prepare the best suited, validated, precut, preloaded, and easy to transplant tissue to reduce pre- and postsurgical complications. This could be achieved by defining parameters like graft thickness, accepted mortality threshold of the endothelial cells, and behavior of grafts during preservation and transportation along with using more sophisticated instruments like microkeratome and femtosecond lasers for graft preparation. Thus, a rapport between the eye banks and the surgeons along with the advanced instruments can overcome this challenge to find the best possible solution for endothelial keratoplasty (EK). 1. Introduction The cornea is the anterior part of the eye globe. It is an avascular tissue which is directly exposed to the external environment. It focuses the image by refracting the light to the retina through a lens. Hence, it should be clear and well maintained for optimal visibility [1]. The cornea acts as a shield against external dust or microbes and prevents them to enter the eye globe. Damage or disturbance to the cornea due to scar, foreign bodies, or other diseases or disorders can lead to poor visibility. Cornea is made up of six layers which are responsible for the organization of the corneal cellular matrix which in turn is important for guiding the light to the retina. The corneal layers are the epithelium, basement membrane, BowmanĄ¯s layer, stroma, DescemetĄ¯s membrane, and endothelium (Figure 1) [1]. Each layer has its own specificity, but when corneal transplantation especially penetrating keratoplasty (PK)/endothelial keratoplasty (EK) is considered, the endothelium has a more important role to play as it does not have the capacity to regenerate and hence should be left viable and undisturbed. Endothelial damage or poor viable cell count is assumed to be majorly responsible for graft rejection [2]. Figure 1: Different layers of a corneal tissue and types of surgeries that involve specific layers. DALK replaces the
%U http://www.hindawi.com/journals/joph/2013/769860/