A Comparison of Posterior Lamellar Keratoplasty Modalities: DLEK vs. DSEK

PURPOSE: To compare clinical outcomes after deep lamellar endothelial keratoplasty (DLEK) with Descemet stripping endothelial keratoplasty (DSEK) performed as initial cases by a single surgeon. METHODS: Sixteen patients with corneal endothelial were enrolled. Eight patients (8 eyes) underwent DLEK and 8 patients (8 eyes) DSEK. We measured uncorrected visual acuity, best corrected visual acuity (BCVA), manifest refraction, corneal endothelial count, interface opacity via Schiempflug imaging, and contrast sensitivity, as well as tracked postoperative complications over the first postoperative year. RESULTS: Primary graft failure occurred in two DLEK cases and one DSEK case, all of which were excluded for further analysis. The average 12-month postoperative BCVA was 20/70 in the DLEK group and 20/50 in the DSEK group, with the difference not statistically significant. No significant differences were identified between the 2 groups in terms of mean spherical equivalent and refractive astigmatism, although individuals in the DSEK group tended toward hyperopia. The average endothelial cell count at postoperative month 12 was 1849+/-494 in the DLEK group and 1643+/-417 cells/mm2 in the DSEK group, representing cell losses of 26.2% and 31.9%, respectively. No significant differences in endothelial cell count or endothelial cell loss were observed between groups. Early postoperative donor disc dislocation occurred in two eyes after DLEK and one eye after DSEK. Interface opacities and contrast sensitivities were similarly not significantly different between groups. CONCLUSIONS: No significant differences in any assessed clinical outcome were observed between individuals undergoing DLEK and DSEK, when performed as initial cases by a single surgeon.

Case Report: Femtosecond Laser-Assisted Small Incision Deep Lamellar Endothelial Keratoplasty

PURPOSE: To report two cases of femtosecond laser-assisted small incision deep lamellar endothelial keratoplasty (DLEK) for patients with corneal endothelial decompensation by Fuchs dystrophy and glaucoma METHODS: Femtosecond laser (IntraLase(R); IntraLase Corp., Irvine, CA) with 15 kHz of repetition rate, was used for a 9.5 mm diameter by 400 micrometer thickness donor corneal lamellar dissection. RESULTS: In Case 1, the graft was clear and compact without interface haze, Orbscan showed smooth and regular corneal surface, specular microscopy was unremarkable without sign of corneal endothelial damage, and Optical coherence tomography showed uniform graft well attached to recipient stroma with minimal interface reflection at 2 months postoperation. In Case 2, the graft was clear and compact with minimal interface haze at 1 month postoperation. Femtosecond laser-assisted small incision DLEK was safe and technically feasible in our cases; however, further evaluation is required to determine long-term effects.

Case Report: Femtosecond Laser-Assisted Small Incision Deep Lamellar Endothelial Keratoplasty

PURPOSE: To report two cases of femtosecond laser-assisted small incision deep lamellar endothelial keratoplasty (DLEK) for patients with corneal endothelial decompensation by Fuchs dystrophy and glaucoma METHODS: Femtosecond laser (IntraLase(R); IntraLase Corp., Irvine, CA) with 15 kHz of repetition rate, was used for a 9.5 mm diameter by 400 micrometer thickness donor corneal lamellar dissection. RESULTS: In Case 1, the graft was clear and compact without interface haze, Orbscan showed smooth and regular corneal surface, specular microscopy was unremarkable without sign of corneal endothelial damage, and Optical coherence tomography showed uniform graft well attached to recipient stroma with minimal interface reflection at 2 months postoperation. In Case 2, the graft was clear and compact with minimal interface haze at 1 month postoperation. Femtosecond laser-assisted small incision DLEK was safe and technically feasible in our cases; however, further evaluation is required to determine long-term effects.

Results of Deep Lamellar Endothelial Keratoplasty (DLEK)

PURPOSE: To evaluate the clinical results of deep lamellar endothelial keratoplasty (DLEK) surgery in patients with bullous keratopathy. METHODS: Seven eyes of 7 patients diagnosed with bullous keratopathy were evaluated for pre- and postoperative visual acuity, refractive error, astigmatism, and corneal topographic results. Specular microscopy and corneal pachymetry was performed in order to evaluate the corneal endothelial cell status. Postoperative complications such as graft rejection, infection, glaucoma, and graft dislocation were also evaluated. RESULTS: Preoperative visual acuity improved from 0.006 (CF ~ 0.02) to 0.4 (0.1 ~ 0.5) at an average of 1.2+/-0.18 years of follow-up. Manifest refraction, topographic astigmatism, corneal endothelial cell density, and central corneal thickness at the final visit were 1.21+/-0.73D, 2.1+/-0.70D, 1304+/-682 cells/mm2, and 504+/-128 micrometer respectively. Two eyes (28.6%) developed graft rejection, one of which recovered after intensive steroid treatment. However, one patient (14.3%) underwent penetrating keratoplasty due to graft failure at 6 months postoperatively. Seven of 7 eyes were noted to have graft dislocation, all of which were repositioned and attached after air injection or suture. CONCLUSIONS: DLEK surgery is an effective alternative to conventional penetrating keratoplasty for bullous keratopathy patients because of fast visual recovery and low incidence of postoperative astigmatism.