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Subspecialties Cornea / Ocular Surface

The Pros of PDEK

Blindness induced by corneal disease continues to be a huge public health burden, with estimates that it affects around 1.5 million people worldwide (1). Corneal transplantation is an effective treatment option for many patients and has a high success rate in restoring sight, but there’s a catch: the severe shortage of donor corneas means that demand far outstrips supply. And even when donor corneas are available, contamination poses a real risk (2), further reducing the amount of viable tissue available.

Much research has focused on improved methods for early corneal disease diagnosis, as well as on advanced surgical methods that optimize our use of the tissue that we have available to us. With that in mind, one such surgical method, pre-Descemet’s endothelial keratoplasty (PDEK), is effective regardless of donor age (3, 4, 5).

Simply put, the PDEK technique transplants the pre-descemet’s layer (PDL) along with descemet’s membrane (DM) endothelium, which are separated from the residual donor stroma through the formation of a type-1 big bubble (BB). Here we describe the technique, which not only minimizes the use of donor tissue, but it can also be applied using adult and infant donor tissue, too, making it an important one for corneal surgeons to master.

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About the Authors

Priya Narang

Priya Narang is the Director and Chief consultant at Narang Eye Care and Laser Centre in Ahmedabad, India.


Amar Agarwal

Amar Agarwal is a pioneer of microincisional cataract surgery. He was first to remove cataracts through a 0.7 mm tip; first to develop no-anesthesia cataract surgery; first to implant a glued IOL; first to implant a mirror telescopic IOL in AMD, and first to use Trypan blue as an epiretinal membrane stain. He coined the term “aberropia” to describe uncompensated HOA profiles following refractive surgery, and produced a modified Malyugin ring for miotic pupil cataract surgeries with posterior capsular defects. Most recently, he and Harminder Dua (qv) pioneered Pre-Descemet’s Endothelial Keratoplasty, which allows for the use of younger corneal donors than previous techniques, greatly increasing the donor tissue pool. He’s also chairman of Dr. Agarwal’s Eye Hospital group – a major chain of eye hospitals, headquartered in Chennai, with more than 40 other branches across India, and a further 12 overseas.

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