Is There a Cutoff in Favor of Penetrating Keratoplasty Rather than Endothelial Keratoplasty for Long-Standing Endothelial Decompensation?

Endothelial keratoplasty (EK) has evolved to become the standard of care over traditional penetrating keratoplasty (PK) for treating isolated corneal endothelial disease. EK provides numerous advantages including faster, more reliable visual rehabilitation, along with a lower allograft rejection rate. There are some situations, however, in which EK may not necessarily be the best option, and PK should at least be considered. In such situations, a careful weighing and balancing needs to be done in conjunction with the patient.