DSEK provided excellent refractive and reasonable visual outcomes in our limited series, but there were frequent problems with dislocation of the donor tissue, and the graft failure rate was high. The graft failures may be linked to excessive endothelial damage, and the high dislocation rate may be linked to not filling the anterior chamber totally with air after insertion of the donor. Further development of the procedure is necessary.

Aims-Data are presented on the use of deep lamellar keratoplasty (DLK) using lyophilised donor corneal tissue, in the management of patients with keratoconus (KC). Method-The results of DLK on 44 eyes (42 patients) are reported. The mean patient age was 29.8 years (range 10-56). Mean follow up was 25 months (range 6-100). In seven patients with mental handicap or severe mental illness, the collection of acuity and refractive data was limited. Results-Perforation of Descemet's membrane (DM) occurred in nine cases (20%).A double anterior chamber formed in five cases, which resolved spontaneously in three patients. Persistent epithelial defects occurred in two cases, one of which necessitated replacement of the graft. The median postoperative uncorrected visual acuity was 6/36. The median corrected postoperative acuity was 6/9. Those with more than 1 year of follow up (n=25) had a significantly better acuity (p=0.015). This group achieved 6/12 or better in 80% (n=20) and 6/6 or better in 40% (n=10). The mean postoperative spherical error was +0.28 (SD 3.49) dioptres (D). The mean refractive cylinder was 3.85 (1.87) D. Conclusion-This detailed retrospective study of DLK for the treatment of patients with KC, with an average follow up of 2 years, highlights the advantages and disadvantages of this technique. (Br J Ophthalmol 2001;85:788-791) Keratoconus (KC) is a progressive ectatic stromal dystrophy and one of the commonest indications for corneal grafting.

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Purpose To assess the corneal endothelial cell density following deep lamellar keratoplasty (DLK) carried out by air dissection and with the transplantation of lyophilised tissue.Method Contact endothelial specular microscopy was carried out on a series of patients who had undergone DLK with a minimum of 1 year post-operative follow-up. Results Twenty eyes of 18 patients were examined at follow-up times ranging from 1 to 8 years post-operatively (mean 3 years).Indications for surgery were: keratoconus