Hybrid technique · DMEK vision + DSAEK handling

PDEK: best of both endothelial worlds.

PDEK (Pre-Descemet Endothelial Keratoplasty) transplants the Descemet membrane, endothelium, and a 30-micron pre-Descemet stromal layer (Dua's layer). The result: visual outcomes close to DMEK with surgical handling closer to DSAEK. Useful in complex eyes, repeat transplants, and when DMEK preparation is difficult.

Watch on AAOSmart Splash (DALK)Graft Exchange after DALK

PDEK Endothelial Transplantation with Dr. Ahmed Shaarawy, Shaarawy Cornea Clinic

Why choose us

International standard. Regional access.

Devers-trained endothelial surgeon

Fellowship at Devers Eye Institute under Prof. Mark A. Terry, a leading center for endothelial keratoplasty research and innovation.

AAO 2014 poster on DMEK

Co-authored the AAO 2014 poster on DMEK in corneas with prior refractive surgery (with Mark Terry's group). PDEK is the natural extension of that work.

Right donor, right technique

PDEK is especially useful with young donor tissue (where DMEK preparation can fail). We select the technique based on the donor age and your anatomy.

Lower rejection vs PKP

Like DMEK and DSAEK, PDEK only replaces the inner cornea, leaving the front surface intact and lowering rejection risk dramatically vs full-thickness grafts.

Letter of recommendation

In Prof. Mark Terry's own words

Excerpts from the letter Prof. Mark A. Terry, Director of Corneal Services at the Devers Eye Institute, wrote for Dr. Shaarawy on 25 January 2015, at the end of his time in Portland.

In surgery, Ahmed assisted me in complex cataracts, anterior segment reconstructions, ocular surface reconstructions, and all forms of corneal transplantation including DMEK, DSAEK, DALK and PK. I often relied upon his observations during surgery and his objective advice when we got into difficult situations on complex cases. I have no doubt that he will deliver the kind of surgical care that will be the envy of his peers when he returns to Egypt.

In his research efforts for his thesis on relaxing incisions in DALK and PK patients, Ahmed was thoughtful and thorough and his insights have advanced the field. He initiated multiple experiments in the laboratory looking at endothelial damage from the iris and the IOL that can occur in DSAEK and DMEK surgery. In addition, he demonstrated amazing ingenuity in his laboratory experiments with alternate ways to unscroll the DMEK graft in the anterior chamber, a key stumbling block for many novice DMEK surgeons.

Legacy Health letterhead: Letter of Recommendation, Ahmed Mohammad Alshaarawy

In summary: Dr. Ahmed Alshaarawy is an excellent and compassionate clinician, a surgeon on the cutting edge of corneal transplant techniques, and a scientist with unique perspectives and boundless energy that will lead to exciting discoveries in our field. Whatever clinical and academic program he chooses will benefit immensely from his membership. Mark A. Terry, M.D., Director, Corneal Services, Devers Eye Institute, January 25, 2015.

Tripoli, March 2022

Libya's national corneal transplant programme

Visiting surgeon for the programme the Libyan Ministry of Health launched at Tripoli University Hospital: about 20 corneal transplants in one week, restarting the surgery there after a pause of nearly eight years.

The full story and sources

Do you wake up with foggy vision?

Corneal edema symptoms as you actually see them

Endothelial dystrophy (Fuchs / inner-cell loss) causes foggy vision that's worst in the morning and improves slightly through the day. Drag the divider to see what patients experience.

Normal vision

With corneal edema

Driving at night

Soft halos and glare around lights, especially in low-light conditions

Read this text clearly

A clear inner cornea keeps vision crisp

Read this text clearly

A clear inner cornea keeps vision crisp

Normal vision

With corneal edema

Reading

Foggy as if looking through a misted window, worst in the morning

Normal vision

With corneal edema

Eye chart

Uniformly blurred letters, improves slightly through the day but never sharpens

Book an inner cornea assessment Ask on WhatsApp

A cell count and a corneal thickness scan show the state of the inner layer, not this picture.

Procedures & pricing

Transparent USD pricing.

Final cost is set after clinical examination. Local-currency equivalents available on request. Insurance reports issued for international patients.

Procedure	Best for	From (USD)
PDEK (standard)	Endothelial keratoplasty, same price band as DMEK/DSAEK; final quote after examination	$3,000 - $3,500
PDEK + cataract (triple)	Combined with phaco + IOL, total depends on the IOL tier you choose	$3,600

تجربة مريض حقيقية

Watch a real patient's experience with Dr. Ahmed Shaarawy

A real patient goes through the whole case, from diagnosis to restored vision after posterior (endothelial) corneal transplantation.

Common questions

Frequently asked.

How is PDEK different from DMEK?

DMEK transplants only the Descemet membrane + endothelium (~10-15 microns). PDEK adds a thin pre-Descemet stromal layer (~30 microns total). The added layer makes the graft easier to handle in surgery and gives almost identical visual outcomes to DMEK.

When is PDEK preferred over DMEK?

Two main scenarios: (1) young donors where DMEK preparation often tears the membrane, and (2) complex anterior segments (prior glaucoma surgery, very shallow chambers) where DMEK manipulation is difficult.

What's the recovery time?

Similar to DMEK: useful vision in 2-4 weeks, full stability in 3-6 months. You'll need to keep your head face-up for the first 24 hours so the air bubble holds the graft in place.

Book your consultation

Pick a day and time. The first visit is an eye exam with Dr. Ahmed Shaarawy, who tells you which option suits your eyes.

Send your case for an endothelial-transplant recommendation.

We'll review your specular microscopy, OCT, and any prior surgical history to recommend whether DMEK, DSAEK, or PDEK is the right choice for your eye, and the all-in cost.

Book a consultation Chat on WhatsApp

Medical references

Agarwal A, Dua HS, Narang P, Kumar DA, et al. "Pre-Descemet's endothelial keratoplasty (PDEK)." Br J Ophthalmol. 2014;98(9):1181-1185. PMID: 24659352. The paper that first described PDEK: five eyes, graft attachment in every case, mean graft thickness 28 ± 5.6 µm.
Dr. Ahmed Shaarawy: 20+ years of corneal and refractive surgery, Devers Eye Institute fellowship (Portland, Oregon), two surgical techniques published in the AAO video series. The figures on this page come from the published literature, not from this clinic's own patients.