Deep Lamellar Endothelial Keratoplasty (DLEK) for Management of Corneal Endothelial Disorders

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.