[Deep lamellar endothelial keratoplasty for bullous keratopathy].

Objective: To investigate the efficacy, postoperative complications and management of deep lamellar endothelial keratoplasty (DLEK) in complex cases of severe bullous keratopathy.

Methods: In the nonrandomized retrospective consecutive case series, fifteen cases (15 eyes) of severe and complex bullous keratopathy at Zhongshan Ophthalmic Center underwent DLEK in combination with other intraocular surgeries between October 2005 and March 2006. DLEK was combined with vitrectomy and ciliary sulcus sutured intraocular lens implantation in two patients, with vitrectomy and intraocular lens extraction in two patients and with vitrectomy and intraocular lens exchange in one patient Four patients with aphakic eyes underwent subsequent ciliary sulcus sutured intraocular lens implantation within 4 to 6 months after the DLEK donor tissue had been placed. The best spectacle corrected visual acuity (BSCVA), corneal astigmatism, curvature and endothelial cell density (ECD) were examined preoperatively and postoperatively. The graft-host interface was photographed by anterior segment optic coherent tomography (OCT). Repeated Measures Anova was applied for management of the data.

Results: On postoperative day 1, 13 grafts were well attached to the host except for one dislocation (re-located immediately and well attached). Fluid leakage between the graft-host interface occurred in one eye (absorbed on day 5). All the grafts remained clear during the follow-up. Five cases (33.3%) showed narrow gaps between the borders of graft and host. Bullous epithelial lesion reoccurred above the gap in two cases (13.3%), and disappeared during follow-up. BSCVA in 4 eyes (26.7%) was 0.4, in 3 eyes (20.0%) was 0.3, in 4 eyes (26.7%) was 0.2, and in 1 eye (6.7%) was 0.1 after DLEK. At 6, 9 and 12 months, the average corneal astigmatism were (2.80 +/- 0.70) D, (2.60 +/- 0.70) D and (2.20 +/- 0.60) D (F = 5.591, P = 0.090), average corneal curvature were (43.60 +/- 1.90) D, (44.10 +/- 1.30)D and (44.10 +/- 1.00) D (F =1.515, P = 0.237). The average central corneal thickness were (666.1 +/- 70.6) microm, (544.5 +/- 30.9) microm, (538.2 +/- 34.7) microm and (532.4 +/- 41.6) microm (F = 32.692, P = 0.000) at preoperatively, 6, 9 and 12 months postoperatively, respectively. The mean ECD was (1915.7 +/- 90.8) cells/mm2 postoperatively.

Conclusions: DLEK surgery is an effective and safe procedure in severe and complex cases of bullous keratopathy,but it has to be successfully combined with other anterior segment surgeries. DLEK graft without sutures can tolerate subsequent other anterior segment surgeries at 4 to 6 months after placement of the donor tissue.