Early postoperative complications of deep lamellar endothelial keratoplasty.

Purpose: To report and discuss the early postoperative complications of deep lamellar endothelial keratoplasty (DLEK).

Methods: The records of the first 44 patients who underwent DLEK by 1 surgeon were reviewed. Complications occurring between the first day and eighth week after surgery were recorded.

Results: In 6 patients (13.6%), the donor disc was floating in the anterior chamber on the first postoperative day and was repositioned with a 30-gauge needle. Fluid was present between the cornea and the disc in 8 patients (18.2%); in 6 of them, the fluid absorbed spontaneously. In 2 patients, the fluid was aspirated 1 month after surgery, but fibrosis developed in the interface. Two patients (4.5%) had persistent corneal edema. In 1 of them, the edema resolved after 2 months, but the other needed penetrating keratoplasty. One patient (2.3%) developed endothelial graft rejection when steroid treatment was discontinued because of exacerbation of preexisting glaucoma. Ten patients (22.7%) had elevated intraocular pressure (IOP) before surgery. The pressure was controlled with topical medication after surgery in 7 patients, 1 patient (mentioned above) suffered graft rejection, 1 patient underwent repeat trabeculectomy, and 1 patient needed insertion of a glaucoma valve. Three patients (6.8%) who did not have glaucoma before surgery developed elevated IOP postoperatively, which was controlled with topical medication.

Conclusion: Non-adhesion of the disc and elevated IOP were the most common complications after DLEK. The mechanical preparation of a thinner donor disc and more experience may lead to fewer postoperative complications and their more efficient management.