One Year Outcomes of Deep Lamellar Endothelial Keratoplasty D'L'E'K'

1
One Year Outcomes of Deep Lamellar Endothelial
Keratoplasty (D.L.E.K.)

• Robert A. Eden, MD
• Robert L. Schultze, MD
• Albany Medical College, Albany, NY

2
Purpose

• Evaluate overall outcome parameters of patients
  undergoing DLEK
• Compare Outcomes in Small Vs. Large Incision.
• Compare Outcomes of Dislocated Vs. Non-Dislocated
  Grafts.

3
Methods

• Twenty One consecutive patients underwent DLEK
  using an automated keratome for graft
  preparation.
• Eight procedures were done using a small (5.5mm)
  Limbal based incision and Thirteen procedures
  were done using a large (9.5mm) Limbal based
  incision.
• Outcome parameters
• BCSVA
• Endothelial Cell Mortality
• Average Change in Corneal Astigmatism

4
RESULTS

• Overall at one year post-op, BSCVA improved from
  an average of 20/125 (range 20/32 to CF 3) to
  20/45 (range 20/16 to CF 3) (4.5 lines of
  improvement.)
• Small incision had 5 lines improvement in BSCVA
  at one year.
• Large incision had 3 lines improvement in BSCVA
  at one year.
• Two patients with Retinal pathology were not
  excluded from this series.

5
RESULTS

• Endothelial Cell Count dropped from 3043
  cells/mm2 to 1434 cells/mm2 (53 decrease.)
• Small incision showed a 55 decrease in cell
  count.
• Large incision group showed a 52 decrease.

6
RESULTS

• An average change of 1.28 /- 1.22 diopters in
  keratometry over one year.
• There was a change of 0.94 /- 0.62 diopters with
  the small incision.
• There was a change of 1.58 /- 1.56 diopters with
  the large incision.

7
Results

• Six of the Twenty one patients (28 ) experienced
  graft dislocation
• Five of the dislocations were in the small
  incision group (62.)
• One dislocation was in the large incision group
  (8),

8
BSCVA ECC Mortality
9
Conclusions

• The small incision group had a significantly
  higher rate of dislocation, however there was no
  statistical difference in outcome after
  repositioning of graft.
• This may be due to endothelial cell shock as a
  result of tissue folding
• No statistical difference between the small and
  large incisions in terms of BSCVA and Endothelial
  mortality at one year
• There was less change in Keratometry in the small
  incision group, but the sample size did not
  provide enough power to be statistically
  significant.

10
Conclusions

• One year post DLEK results employing both a small
  and large incision indicate it to be a safe
  procedure with encouraging visual results.
• Further study is required to determine if the
  theoretical advantages to a smaller incision
  outweigh the apparently high dislocation rate
  demonstrated in this series.
• Continued follow up of these patients is
  important to determine if dislocation with
  repositioning affects the long term survival of
  the endothelial grafts.