Early postoperative complications of deep lamellar endothelial keratoplasty

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

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.

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.

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.