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Lamellar surgery may have advantages over PK for endothelial dysfunction
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PORTLAND, Ore. — A lamellar surgical approach may offer advantages over penetrating keratoplasty for treating endothelial dysfunction, according to Mark Terry, MD. The procedure involves no corneal surface incisions or sutures, Dr. Terry said, and it minimizes astigmatic and corneal power changes.
Dr. Terry assessed the safety and efficacy of deep lamellar endothelial keratoplasty (DLEK) in eight eyes of eight patients with corneal edema from Fuchs' dystrophy and pseudophakia. He reported the results in these patients at 6 and 12 months.
Dr. Terry described the procedure in an article in Ophthalmology. A 9-mm limbal, scleral, partial-depth incision is created to provide access for a deep lamellar corneal pocket dissection. A 7.5- to 8-mm posterior lamellar disc of recipient tissue is then excised and replaced through the pocket with a donor disc of the same size containing healthy endothelium. A bubble of air in the anterior chamber is used to create tissue adherence, and no suturing is needed.
At both 6-month and 12-month follow-up, all corneas were clear and the grafts were healed in good position, Dr. Terry wrote. At the 6-month mark, best corrected visual acuity (BCVA) ranged from 20/30 to 20/70, with an average change in astigmatism from preop of +1.13 D. The average change in corneal power was –0.4 D, average pachymetry was 648 µm and average endothelial cell count was 2290 cells/mm2.
In the four eyes that reached 12-month follow-up, endothelial density was an average of 2409 cells/mm2. Three of the four eyes that reached this follow-up stage were 20/40 or better and had a corneal power change of –1.3 D.