ABSTRACT
To evaluate the visual outcomes and complications of deep lamellar endothelial keratoplasty [DLEK] for management of corneal endothelial disorders. From 2003 to 2005, nine eyes of nine patients with severe bullous keratopathy due to endothelial dysfunction underwent DLEK. Uncorrected [UCVA] and best-corrected [BCVA] visual acuity were evaluated pre- and one week, 1, 3 and 6 months postoperatively. The sutures were removed 3-4 months postoperatively in all eyes. Five female and four male subjects with mean age of 66.3 +/- 10.9 years underwent DLEK. Preoperative diagnoses included aphakic bullous keratopathy [ABK, 2 cases], pseudophakic bullous keratopathy [PBK, 4 cases] and Fuchs' endothelial dystrophy [FED, 3 cases]. Mean BCVA was 1.7 +/- 0.5 LogMAR [20/1000] preoperatively which improved to 1.4 +/- 0.1 LogMAR one month [P=0.02], 1.4 +/- 0.2 LogMAR three months [P=0.04] and 1.2 +/- 0.4 LogMAR six months [P=0.01] postoperatively. Mean corneal astigmatism was 7.43 +/- 5.02 diopters one month after DLEK which decreased to 4.06 +/- 3.58 at final follow up. All eyes had clear graft and cornea after 6 months. Postoperative complications included transient leakage [two eyes], lenticule displacement, graft wrinkling, double chamber formation, mild interface hemorrhage and filamentary keratitis [each in one case]. Cystoid macular edema was present in four eyes. DLEK has acceptable results for replacement of the endothelium in patients with ABK, PBK and FED. The most important drawback of this technique is the complexity of the equipment and the procedure. DSAEK [Descemet stripping automated endothelial keratoplasty] seems to be replacing DLEK due to less dependence on instruments and being a more simple procedure
ABSTRACT
To evaluate the prevalence, natural course, and final visual acuity in patients with stages III or IV of diffuse lamellar keratitis [DLK] following Laser in situ keratomileusis [LASIK]. In this descriptive study, records of all the patients who underwent LASIK surgery in two private excimer laser clinics were reviewed. According to Linebarger- Lindstrom-Hardten classification, ocular findings of patients with DLK were classified. There was no preoperative systemic or corneal contraindication for LASIK. Age, preoperative refraction and best corrected visual acuity [BCVA], type and duration of treatment, postoperative refraction, topography, final BCVA, possible side effects of medications and complications were reviewed. Out of 4097 eyes of 2131 patients, DLK above stage II developed in 28 eyes [0.68%] of 14 patients [0.66%]. DLK was in stage II-III in 78.6%, stage III in 10.7%, and stage IV in 1.7%. None of these patients had history of allergies. Treatment consisted of frequent betamethasone drops alone or with ointment and oral systemic prednisolone. Interface irrigation was not performed in any patients during the course of treatment. Average interval from LASIK to diagnosis was 3 +/- 1.5 days. Patients were treated for an average duration of 20 +/- 13.2 days and were followed for an average duration of 11 +/- 10 months. Average preoperative BCVA was 0 LogMAR [20,20] and final post LASIK and DLK vision remained the same. Prevalence of DLK stages III and IV is considered insignificant as compared to the enormous number of candidates for LASIK surgery [0.68%]. All patients with DLK stages III and IV responded well to immediate topical and systemic corticosteroid therapy and on follow up there was no adverse effect on final BCVA