Large series highlights positive outcomes of DLEK

New Orleans-Deep lamellar endothelial keratoplasty (DLEK) should be considered first for patients with endothelial dysfunction requiring corneal transplant surgery, said Mark A. Terry, MD.

He presented data collected from his personal, consecutive series of 90 DLEK eyes and compared their outcomes with historical data for penetrating keratoplasty (PKP). The 90 DLEK eyes included 36 eyes operated on with a technique using a 9-mm scleral axis incision and 54 that had a 5-mm incision that necessitated folding of the donor tissue when putting it into the pocket. Forty-nine patients were pseudophakic at the time of DLEK and 36 underwent DLEK combined with phacoemulsification. Two cases were converted to PKP intraoperatively due to surgeon error.

The refractive and visual acuity results at 6-months were comparable for the small and large incision techniques, and in the overall series, mean BSCVA was 20/46, mean manifest refractive astigmatism was 1.35 D, and endothelial cell count averaged 2,144 cells/mm², representing a 24% loss from preop.

"You won't find astigmatism results like this in any PKP study in history, and the endothelial cell counts are equal to or better than those we see in standard PKP," Dr. Terry said.

He also emphasized that a number of complications associated with PKP were not seen in this group.

"In the five phakic cases where a clear crystalline lens was left in place, no cataract developed. We had no late dislocations of the donor button, no eyes with infection, no ulcerations, none of the patients have needed LASIK or relaxing incisions, and all are able to wear normal spectacles," Dr. Terry said.