Abstract

In the last ten years, new lamellar keratoplasty methods have been developed, including Descemet stripping automated endothelial keratoplasty/Descended membrane endothelial keratoplasty (DMEK) for posterior keratoplasty and Deep Anterior Lamellar Keratoplasty (DALK) for anterior keratoplasty. Endothelial allograft rejection, the primary cause of graft failure following penetrating keratoplasty, is prevented by DALK. With DSAEK/DMEK, the risk of endothelial graft rejection is much lower than it was after PK. Thus, in the low-risk scenario, the clinical issue of endothelial graft rejection appears to be almost completely resolved with modern lamellar procedures. There are endothelial immune reactions in DSAEK/DMEK and epithelial, subepithelial, and stromal immune reactions in DALK, even with lamellar grafts, and not all keratoplasties can be done in a lamellar way. Therefore, In the “high-risk” situation, where the cornea’s (lymph)angiogenic and immunological privilege is lost as a result of acute inflammation and pathological neovascularization, endothelial graft rejection in PK is still very important. The therapy solutions that are currently available for these eyes are still inadequate. We will discuss the four most popular keratoplasty procedures in this review: PK, DALK, DSAEK, and DMEK. We’ll list their indications, describe the procedures, and make observations on any issues or results. We will also provide an overview of the immunology of corneal transplants. Endothelial graft rejection will receive particular attention, and we will report on its prevalence, clinical manifestation, and available treatments and preventative measures. Finally, we will project future developments in the fields of keratoplasty and preventing corneal allograft rejection.

Keywords: Corneal transplantation; Keratoplasty; Graft rejection