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DSAEK will soon replace conventional PK surgery for the treatment of endothelial decompensation
Where did it all begin?
In those patients suffering from endothelial decompensation (both primarily, i.e., Fuchs dystrophy, and secondarily after cataract surgery) but with an otherwise healthy cornea, simple "substitution" of the diseased endothelium with donor cells would succeed in both treating the pathologic condition and eliminating most of the complications related to conventional PK surgery.
All was not forgotten
Posterior lamellar keratoplasty was forgotten for three decades, until in 1993 Ko presented a poster at the annual ARVO meeting in Fort Lauderdale, describing a new technique of PLK in a rabbit model: both removal of the posterior lamella from the recipient and implantation of the donor posterior graft were performed through a sclero-corneal tunnel without "touching" the anterior corneal surface. However, hand-dissection of the recipient cornea was difficult and the resulting surface, even in the best cases, was never of an optical quality compatible with 20/20 vision.