Deep Lamellar Endothelial Keratoplasty: Surgery in Complex Cases With Severe Preoperative Visual Loss

Amayem, Ashraf; Terry, Mark A.; Helal, Magdy; Turki, Walid Al; El-Sabagh, Hazem A; El-Gazayerli, Erfan; Ousley, Paula J.

doi:10.1097/01.ico.0000153558.67031.15

Cited by 22 publications

(12 citation statements)

References 20 publications

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“…[34][35][36][37] Other authors 38,39 also adopted the DLEK procedure and reported good success in their patients even when it was combined with other intraocular procedures. 40 Melles et al 41 again revolutionized the field by instituting a significant modification to facilitate greatly the PLK procedure-they described a technique in which they simply stripped the Descemet membrane from the recipient, thus converting the DLEK procedure to the procedure known as DSEK (Fig. 5).…”

Section: Posterior Lamellar Keratoplastymentioning

confidence: 98%

Future Directions in Lamellar Corneal Transplantation

Tan¹,

Mehta²

2007

Cornea

131

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The concept of lamellar keratoplasty (LK) is that of targeted lamellar replacement of corneal tissue while retaining normal cornea. It involves replacing either anterior stroma [anterior lamellar keratoplasty (ALK)] or posterior replacement of deep stromal and endothelial layers [posterior lamellar keratoplasty (PLK) or endothelial keratoplasty]. Despite the distinct advantages of ALK surgery, penetrating keratoplasty (PK) remains the most common procedure-largely because lamellar surgery is more technically demanding and time consuming, and interface irregularity arising from manual lamellar dissection often results in suboptimal visual outcomes. Recent improvements of surgical technique and advances in instrumentation such as microkeratome-assisted lamellar transplantation have contributed to improved visual quality with LK surgery. Long-term graft survival rates and endothelial cell counts after PK continue to drop for many years after surgery, clearly showing the disadvantage of unnecessary replacement of healthy endothelium in anterior-stromal disorders. The aim of this review is to evaluate the shifting emphasis from penetrating to lamellar forms of corneal transplantation and to highlight some future directions in lamellar surgery including new techniques in both ALK and PLK and the use of microkeratomes and femtosecond lasers to enhance outcomes.

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Section: Posterior Lamellar Keratoplastymentioning

confidence: 98%

Future Directions in Lamellar Corneal Transplantation

Tan¹,

Mehta²

2007

Cornea

131

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“…Fogla et al observed an average endothelial cell count of 1,732 cells/mm 2 , which reflects a 15% endothelial cell loss at 6 months [33]. Amayem et al evaluated the endothelial cell loss in six patients after complex case 9-mm DLEK [30]. Mean endothelial cell loss at 6 and 12 months was 48 and 65%, respectively.…”

Section: Plk/dlekmentioning

confidence: 96%

“…Amayem et al performed DLEK surgery on six patients with severe bullous keratopathy and preoperative vision between light perception and counting fingers [30]. DLEK was combined with vitrectomy and placement of a ciliary sulcus IOL in four patients and with cataract surgery in one patient.…”

Section: Effect Of Concomitant Proceduresmentioning

confidence: 99%

“…Forty-nine percent of all eyes after DLEK achieved a best-corrected vision of 20/40 or better (n = 98). Amayem et al has shown that DLEK may be used in combination with other intraocular surgeries in the treatment of eyes with severe bullous keratopathy and severe vision loss[30]. In six patients, best spectacle corrected vision improved from counting fingers or worse before surgery to20/137 (range 20/40 to 20/200) 6 months after surgery.…”

mentioning

confidence: 98%

“…to 1.63 D[23][24][25][26][27][28][29][30]33]. Melles described a mean astigmatic error in seven eyes after large incision PLK of 1.54 ± 0.81 D[25].…”

mentioning

confidence: 99%

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Surgical alternatives to penetrating keratoplasty II: endothelial keratoplasty

Goins

2007

Int Ophthalmol

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Penetrating keratoplasty (PK) became the standard of care for optical and tectonic rehabilitation of corneal blindness and visual impairment in the second half of the twentieth century. Posterior corneal disorders or endotheliopathies are the reason for one-third to one-half of all corneal transplants today in the US. Any procedure that replaces the endothelium ideally should accomplish the following results: (1) a smooth surface topography without significant change in astigmatism, (2) a highly predictable corneal power, (3) a healthy donor endothelium that resolves all edema, (4) a tectonically stable globe, safe from injury and infection, and (5) an optically pure cornea. Although PK consistently can achieve results 3 and 5 above, the other goals of stable topography, predictable corneal power and tectonic stability, have remained elusive despite our best efforts at ingenious suturing and trephination techniques. Endothelial keratoplasty (EK) is a new surgical procedure designed to replace diseased corneal endothelium with healthy donor endothelium through either a lamellar corneal flap approach or through limbal scleral incision, leaving the surface of the recipient cornea untouched by surface corneal sutures. This manuscript evaluates the impact and future of EK in ophthalmology.

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Deep Lamellar Endothelial Keratoplasty for Iridocorneal Endothelial Syndrome in Phakic Eyes

Huang

Wang²,

Ji³

et al. 2009

Arch Ophthalmol

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Objective: To evaluate the efficacy and postoperative complications of deep lamellar endothelial keratoplasty (DLEK) for treating iridocorneal endothelial (ICE) syndrome in phakic eyes.Methods: Retrospective noncomparative interventional case series. Seven consecutive patients (7 eyes) having ICE syndrome with clear or mildly opaque lens were treated using DLEK and were followed up for 9 to 20 months. Data collected included best spectacle-corrected visual acuity, intraocular pressure, corneal astigmatism, endothelial cell density, and peripheral iris and anterior chamber angles using ultrasonographic biomicroscopy. Results: Corneas were clear in all eyes. No graft dislocation or lens injury occurred. During the follow-up period, 2 eyes developed cataract, 1 of which underwent phaco-(REPRINTED) ARCH OPHTHALMOL / VOL 127 (NO.

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Deep Lamellar Endothelial Keratoplasty: Surgery in Complex Cases With Severe Preoperative Visual Loss

Cited by 22 publications

References 20 publications

Future Directions in Lamellar Corneal Transplantation

Future Directions in Lamellar Corneal Transplantation

Surgical alternatives to penetrating keratoplasty II: endothelial keratoplasty

Deep Lamellar Endothelial Keratoplasty for Iridocorneal Endothelial Syndrome in Phakic Eyes

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