Levis found that their plastic compressed collagen carrier could be successfully manipulated and deployed using current graft delivery devices without complication. Also, cultured HCECs express cellular markers characteristic of in vivo HCECs, such as Na+/K+ ATPase, that are in part responsible for the function of the corneal endothelium in maintenance of corneal clarity. Therefore, although more clinical research is needed in this field, the authors feel that the above assumptions are not unreasonable. Some corneal transplant surgeons have reported using single donor corneas for both deep anterior lamellar keratoplasty and EK procedures in two separate recipients. This technique of split cornea transplantation, if widely adopted by surgeons or eye banks, could potentially help to alleviate the shortage of donor corneal tissue. Also, the use of a single donor cornea for two separate transplants would significantly reduce the cost of procured donor tissue for each transplant procedure. However, the impact of this concept is limited by the fact that one of the two procedures would have to be a DALK, which is less commonly GSI-IX Gamma-secretase inhibitor performed than EK procedures like DSEK. Even though DALK is performed quite often in Singapore, it only accounts of corneal transplant procedures performed in the United States. Furthermore, DALK is often performed with tissue that has endothelium that would be unsuitable for EK surgery and hence, this is unlikely to have significant impact on the results of this cost-minimization analysis. Finally, there are limits to the generalization of these results. This analysis was performed in the authors�� setting of Singapore. While we have performed different sensitivity analyses in an attempt to make these results generalizable across various settings, there are PI-103 certain scenarios that are beyond the scope of this paper. First, this analysis was designed from the perspective of an institution that currently has no means of acquiring tissue. Therefore, the results are not immediately applicable to an institution that has already made investments in an eye bank and/or an ALTK system.