The cells of the corneal endothelium are non-renewable. When the number of endothelial cells is reduced to a certain level due to ocular trauma or intraocular surgery, they cannot drain all the water molecules out of the stroma. In the past, the only solution to this problem was penetrating corneal transplantation. In recent years, with the continuous improvement of technology, damage to corneal endothelial cells can be treated by doing corneal endothelial transplantation. What are the advantages of endothelial transplantation compared to penetrating corneal transplantation? Let’s compare. Small and airtight incision and high safety: Most penetrating corneal transplants require general anesthesia because the entire cornea is cut down and the 360-degree circumferential incision exposes the eye tissue to air. If the patient is nervous during surgery, resulting in elevated blood pressure or increased abdominal pressure, etc., the blood vessels in the eye bleed profusely due to the increased pressure, which can cause all the eye tissue to gush out of the opening and a serious complication, explosive bleeding, to occur. Although general anesthesia will reduce this risk, intraoperative patient stress and artificial shaking, combined with the patient’s own poor vascularity and other factors, still leave the possibility of these complications. In contrast, corneal endothelial transplantation has only a 3.25 mm tunnel incision , similar to cataract surgery, and the entire procedure is performed in a closed environment inside the eye without exposing the intraocular tissues. Endothelial transplantation can be performed under local anesthesia, allowing patients to signal their surgeon to take action if they are uncomfortable during the procedure, which is safer. No sutures, less likely to cause astigmatism: After penetrating corneal transplantation, a circle of sutures is required around the cornea, usually about 16 stitches. The normal cornea has a certain curvature (i.e., curvature). After surgery to stitch on the cornea, due to the different healing rates of the wound, no matter how fine and perfect the surgeon’s stitching is, there will be a change in the curvature of the cornea, resulting in a certain degree of astigmatism. In contrast, no sutures are required after corneal endothelial transplantation, and the graft is placed into the eye, unfolded and laminated to the stroma through a small incision. The surgery only replaces the posterior endothelial layer and posterior elastic layer, and the anterior surface of the cornea remains physiologically curved, completely unaffected by the refractive state. Low rejection and fewer complications: Even though the cornea has the lowest rejection rate of all organ transplants, there is still the possibility of rejection. In contrast, corneal endothelial transplantation greatly reduces the chance of rejection because the less foreign material and the less traumatic the surgery, the less chance of rejection and the less postoperative reaction, the faster the patient recovers and the fewer complications. Full utilization of the donor: Endothelial transplantation of the cornea only transplants the endothelial layer and the posterior elastic layer, so that the previous layers can be transplanted to another patient in need, expanding the use of the donor. It is also helpful for the current shortage of donors in our country. Therefore, corneal endothelial transplantation has now gradually replaced penetrating corneal transplantation as the method of choice for the treatment of corneal endothelial lesions due to less damage, faster recovery of vision, and less rejection reactions.