A 68-year-old patient with Fuchs' endothelial dystrophy is undergoing corneal transplantation. The surgeon aims for the best possible visual acuity and faster rehabilitation, accepting a slightly higher initial surgical complexity. Which procedure would best meet these goals?

Explanation

For endothelial diseases like Fuchs' dystrophy, Descemet's Membrane Endothelial Keratoplasty (DMEK) offers superior visual outcomes and faster visual rehabilitation compared to Descemet's Stripping Endothelial Keratoplasty (DSEK) and Penetrating Keratoplasty (PKP). This is because DMEK involves transplanting only the Descemet's membrane and endothelium, which is a much thinner tissue layer than the full-thickness graft in PKP or the stromal-endothelial graft in DSEK. The thinner graft results in less induced astigmatism and a more natural corneal curvature, leading to better optical quality. While technically more challenging than DSEK, the visual benefits are significant. DALK is indicated for stromal disease with healthy endothelium, not primarily endothelial dysfunction.