Deep lamellar keratoplasty for various corneal lesions

To evaluate the efficacy and safety of deep lamellar keratoplasty (DLK) as a method for treating various diseases of corneal stroma with unaffected endothelium.

DLK was performed in 31 eyes of 31 patients with corneal stroma opacity without endothelial abnormalities. Surgical procedures included deep removal of corneal stroma 7.5 mm in diameter with the use of viscoelastic or 0.02% trypan blue solution, exposing Descemet membrane in the central area of about 5 mm across including the area of pupil, and grafting a corneal lenticule. In three cases of postinflammatory stromal scars with coexisting limbal stem cell deficiency, limbal stem cell grafting was additionally performed. Main outcome measures were best-corrected visual acuity (BCVA) and postoperative astigmatism.

Intraoperative perforation of Descemet membrane with the necessity of converting the procedure into penetrating keratoplasty occurred in five cases (16.1%) and one patient underwent penetrating keratoplasty on the seventh day after DLK due to persistent double anterior chamber. These six patients were excluded from the study. Postoperative BCVA ranged from 0.1 to 1.0 and astigmatism from 1.2 to 4.7 D. Postoperative complications were loose sutures, ocular hypertension, Descemet membrane detachment, and corneal melting.

DLK is an effective procedure for treating various diseases of corneal stroma with unaffected endothelium. This technique as an extraocular procedure seems to be the treatment of choice in mentally retarded patients. (Eur J Ophthalmol 2004; 14: #-72).