Pre-Descemet’s endothelial keratoplasty

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    What is PDEK?

    Understanding About


    Pre-Descemet’s endothelial keratoplasty (PDEK) is a surgical technique used for corneal transplantation. It involves transplanting the innermost two layers of the cornea, along with a newly discovered layer called Dua’s layer, from a donor to a recipient. 

    This procedure aims to replace dysfunctional endothelium, which is responsible for pumping water out of the cornea to maintain transparency. PDEK is particularly effective in treating conditions like bullous keratopathy, where the cornea becomes swollen and damaged due to endothelial dysfunction. Compared to traditional whole cornea transplantation, PDEK offers the advantage of a thinner graft, resulting in better visual outcomes.

    Prof. Amar Agarwal and Prof. Harminder Dua were pioneers in introducing and demonstrating the significance of Pre-Descemet’s layer in corneal transplantation through PDEK surgery. They highlighted the importance of using young donor corneas for better clarity and visual outcomes in PDEK procedures.

    Our Doctors

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    Dr. Kasu Prasad Reddy

    M.B, D.O, MRCOphthCheif Cataract & Refractive Surgeon
    Somajiguda, Telangana

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    Dr. P. Muralidhar Rao

    MBBS, M.S, FIVRSr. Vitreo Retinal Surgeon
    Somajiguda, Telangana

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    Dr. V J Ramakumar

    MBBS, M.S , D.OGeneral Ophthalmologist
    Somajiguda, Telangana

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    Dr. Anitha C Kamarthy

    MBBS, M.SSr. Cataract & Glaucoma Surgeon
    Somajiguda, Telangana

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    Dr. B M Anil Kumar

    MBBS, D.O, FLVPEI, MBASr. Glaucoma Consultant
    Somajiguda, Telangana

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    Dr. Vamshidhar

    MBBS, DNB, FICO ( UK)Sr. Cataract & Refractive Surgeon
    Somajiguda, Telangana



    The penetrating keratoplasty surgery is usually performed under local anesthesia. Through a small corneal incision (opening), the endothelium is removed from the patient’s eye and a disc of donor endothelium is inserted in the patient’s eye which is placed in position with the help of an air bubble.

    A few stitches may be taken which will be removed 3-4 weeks after the surgery. Once keratoplasty surgery is over, the patient needs to lie down flat for a few hours for proper attachment of the graft. The air bubble usually gets absorbed in 48 hours but may take longer.

    The donor eye is genetically different from the patient’s body, due to which the patient’s body tries to fight against it. This is called corneal graft rejection. 

    Redness, Sensitivity to light, Vision drop, Pain (RSVP). Along with sticky discharge and foreign body sensation.

    Report to your Ophthalmologist as soon as possible if any of the above symptoms show up post-surgery.

    When the corneal graft rejection has not been promptly treated or does not respond to anti- rejection medication, graft failure has occurred. The only way of managing graft failure is by replacing the graft. In addition, there are three types of graft rejection: acute, hyperacute, and chronic rejection.

    Vascularisation over the cornea, Pre-existing inflammation, Corneal transplant done more than 2 times, Pre-existing glaucoma.



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