Purchase this article with an account.
K. M. Goins, J. Sutphin; Deep Lamellar Endothelial Keratoplasty: Visual Acuity, Corneal Topographic Astigmatism, and Endothelial Cell Density in a Large Prospective Series. Invest. Ophthalmol. Vis. Sci. 2007;48(13):4712.
Download citation file:
© ARVO (1962-2015); The Authors (2016-present)
To report the 6-month results for the treatment of endothelial failure in a large, prospective series of deep lamellar endothelial keratoplasty (DLEK).
From the 91 DLEK procedures performed in 86 patients (55 women; 31 men), the patients were divided into three distinct study groups: large incision 9 mm DLEK [n=7], small incision 5-8 mm DLEK [n=75], and penetrating keratoplasty conversion (PK conv) groups [n=9]. Preoperative and postoperative best-spectacle corrected visual acuity (BSCVA), corneal topographic (CT) astigmatism, and endothelial cell density (ECD) were evaluated prospectively.
The percentage of eyes that had 20/40 BSCVA or better at 6 months were 4/7 eyes (57%) 9 mm DLEK, 36/56 eyes (64%) 5-8 mm DLEK, and 4/9 eyes (44%) PK conv. The mean CT astigmatism was 1.41 +/- 0.60 D [9 mm], 1.94 +/- 1.46 D [5-8 mm], 4.29 +/- 2.0 D [PK conv]. The two DLEK groups showed a 25-37% reduction in CT astigmatism compared to the preoperative state, while the PK conv group showed a 45% increase in astigmatism. The average ECD at 6 months was 2400+/-393 [9 mm], 1710+/-454 cells/mm2 [5 mm], and 2432+/310 cells/mm2 [PK conv]. This corresponded to a 24%, 44%, and 24% loss in ECD as compared to the preoperative state.
In this prospective series, DLEK provided visual acuity outcomes equivalent to those reported after standard PK, with a significant decrease in CT astigmatism. The large incision 9 mm DLEK procedure seems to provide an ECD equivalent to PK. The most concerning issue in this study is the decrease in ECD after small incision DLEK. Folding of the donor tissue prior to insertion has a detrimental effect on the ECD after DLEK. We postulate that folding of the tissue may stimulate a certain population of corneal endothelial cells to undergo apoptosis (i.e. a programmed cell death), which becomes evident by 6 months after DLEK. DLEK is a reasonable alternative to PK, however safer insertion methods will be needed to increase long-term ECD.
This PDF is available to Subscribers Only