Initial results of small incision deep lamellar endothelial keratoplasty (DLEK)

PURPOSE: To evaluate the results of replacing the posterior stroma and endothelium, using small incision deep lamellar endothelial keratoplasty (DLEK) surgical technique, in patients with corneal endothelial dysfunction. DESIGN: Noncomparative case series. METHODS: Fifteen eyes of 15 patients (six males and nine females) with endothelial dysfunction were included in this study. Through a 5-mm scleral incision, a deep lamellar pocket was created across the cornea, followed by excision of an 8.0,mm disk of posterior lamellar corneal tissue. Same size lamellar donor disk was prepared and placed in position without the need of suture fixation. Best spectacle,corrected visual acuity (BSCVA), refraction, endothelial cell density, corneal topography, and corneal thickness were analyzed. RESULTS: Average BSCVA preoperative was 20/200 (range 20/40 to hand movements (HM)), improving to 20/50 (range 20/20 to 20/120) at a mean follow-up of 7.2 months. Average refractive astigmatism at last follow,up was 1.46 +/- 1.21 diopters (range, 0 to 4 diopters). Preoperative average donor endothelial cell density was 2047 +/- 311 cells/mm(2) and that at last follow,up was 2 1732 +/- 514 cells/mm(2). Preoperative average pachymetry was 801.4 +/- 211.3 mu m, improving to 553 +/- 90.4 mu m at last follow-up. CONCLUSIONS: Initial results with small incision DLEK procedure indicate that it is a safe procedure that provides healthy donor endothelial cell count and function postoperatively, with encouraging visual results.