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W Silk, P Gupta, G Stevens; Endothelial Lamellar Keratoplasty: Ten Pateint Series Report . Invest. Ophthalmol. Vis. Sci. 2002;43(13):4177.
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Purpose: To report the results of Endothelial Lamellar Keratoplasty (ELK) as a surgical technique to replace diseased posterior corneal lamella with aim to improve therapeutic and visual recovery time. Method: A total of 10 patients with Bullous Keratopathy (n=7) and Fuchs Corneal Dystrophy (n=3) with best corrected visual acuity ranging from hand motion to 20/60 underwent ELK. In this procedure a 9 mm anterior corneal flap was created using a Moria microkerartome and a 6 to 7 mm diseased posterior stromal button was removed by trephination. Using an artificial anterior chamber, a 6.25 to 7.5 mm donor endothelial button was created and sutured in place. The anterior flap was repositioned and secured with sutures. Eight patients underwent procedures in addition to ELK which included phacoemulsifacation with posterior chamber intraocular lens placement (n=3), iridoplasty (n=3), intraocular lens exchange (n=2), and trabeculectomy with mitomycin C (n=1). Results: All patients tolerated the procedures well. Complications included wound leaks (n=2) and primary graft failures (n=2). There were no graft rejections. Two patients had increased intraocular pressure during the first post-operative day that was successfully managed with medical therapy. Of the 8 out of 10 patients that have reached the two month post-operative period, best corrected visual acuity ranged from hand motion to 20/50. Furthermore 6 out of these 8 patients had excellent stromal and epithelial clarity. Conclusion: ELK is a viable surgical procedure that requires special attention to mechanical stress on the endothelial layer.
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