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I. Brunette, J.–F. Laliberte, J. Meunier, P.J. Ousley, M.A. Terry, the International Corneal Modeling Group; 3D Topographic Comparison of Deep Lamellar Endothelial Keratoplasty (DLEK) Large and Small Incision Techniques . Invest. Ophthalmol. Vis. Sci. 2006;47(13):567.
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© ARVO (1962-2015); The Authors (2016-present)
To compare topography outcome of large and small incisions DLEK techniques, using a 3D mean model methodology (3D atlases).
73 patients (mean age 70.7 ± 10.1 years) underwent DLEK for Fuchs’ dystrophy or pseudophakic keratopathy by one surgeon (MAT): a large 9 mm superior incision (LI) was made in 32 eyes and a 5 mm small temporal incision (SI) in 43 eyes. Pre– and postoperative 3D topographical atlases were generated and compared using Root–mean–square–errors (RMSE). For comparison purposes, a 3D atlas of normal subjects was also used (139 eyes, 55.1 ± 3.7 years).
Analysis of the anterior surface of the atlases showed that in the LI group, DLEK induced against the rule astigmatism. In the SI group, the anterior surface was overall less affected by surgery. Analysis of the posterior surface of the atlases revealed an obvious postoperative anterior shift of the central cornea in both groups (LI: 23.6 µm; p = 0.001; SI: 17.4 µm; p = 0.028), extending inferiorly opposite to the wound in the LI group and temporally towards the wound in the SI group. Pachymetry analysis revealed an obvious postoperative central thinning in both groups (LI: 238 µm; p < 0.001.; SI: 211 µm; p < 0.001), this area of thinning extending inferiorly opposite to the wound in the LI group and temporally towards the wound in the SI group. At six months, central pachymetry was similarly reduced in both groups (p = 0.43). No significant changes in LI and SI atlases were observed between 6 and 12 months (p > 0.05). The shape of SI corneas was closer to that of normal corneas than LI corneas at all–time (pre–op: p = 0.040, 6 months: p = 0.0002, 12 months: p = 0.042).
Rehabilitation of central pachymetry was achieved with both DLEK techniques. The resulting corneal shape obtained with the SI technique was closer to that of normal unoperated corneas than with the LI technique. The 3D mean model methodology (3D atlases) represents a very promising new concept for the 3D anatomical quantification of surgically induced remodelling of the cornea.
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