Purchase this article with an account.
M.A. Terry, P.J. Ousley; Is There a Learning Curve with the Deep Lamellar Endothelial Keratoplasty (DLEK) Procedure? . Invest. Ophthalmol. Vis. Sci. 2003;44(13):4692.
Download citation file:
© ARVO (1962-2015); The Authors (2016-present)
Purpose: Deep Lamellar Endothelial Keratoplasty (DLEK) is a radically new surgical procedure for endothelial replacement. We investigated whether a learning curve may be present with this procedure for optimal visual and topographic results. Methods: 27 patients with Fuchs' dystrophy received DLEK surgery using a 9.0 mm limbal scleral incision. Manifest refractions and corneal topographies were prospectively measured at pre-op and at 6 and 12 months post-op. The results from the first 8 patients (the first year of surgeries; Group 1) were compared to the results in the subsequent 19 patients (Group 2). All patients in both groups had reached at least six months of follow-up. All 8 patients in Group 1 and 11 of 19 patients in Group 2 had reached 12 months follow-up for this analysis. Results: Best spectacle-corrected visual acuity, uncorrected visual acuity, and mean curvature were not significantly different between the two groups at any time point. However, average astigmatism at 6 months was 2.28 + 1.03 D in Group 1 and 1.46 + 0.90 D in Group 2 (P=.048); this significant difference remained at 12 months, with averages of 2.75 + 0.90 and 1.64 + 0.95, respectively (P=.025). Flattening in the vertical meridian occurred postoperatively more often and to a greater extent in Group 1 than in Group 2, producing induced against-the-rule astigmatism refractive error. Conclusions: These results indicate that there was some learning curve with this procedure. The superior wound in DLEK surgeries with 9.0 mm scleral incisions can cause induced flattening. We have learned from our early cases to now suture the wound tightly and reduce against-the-rule astigmatism in DLEK surgery.
This PDF is available to Subscribers Only