Deep lamellar endothelial keratoplasty: early complications and their management.
OBJECTIVE
To report the early vision-threatening complications in a large series of deep lamellar endothelial keratoplasty (DLEK) procedures and discuss the management of these complications.


METHODS
The first 100 consecutive patients to reach the 6-month postoperative gate of a prospective, institutional review board-approved protocol for DLEK surgery were reviewed for intraoperative and postoperative complications. The method of treatment of these complications and the outcome of that treatment were recorded.


RESULTS
Two eyes (2 of 100 = 2%) were converted to PK at the time of DLEK surgery. Of the 98 patients who had complete DLEK surgeries, 4 eyes (4 of 98 = 4%) were noted to have a dislocated disk on the first postoperative day. The dislocated disk in each case was repositioned in a short, often topical anesthesia technique, and all corneas cleared. One eye had primary graft failure (caused by surgeon error) resulting in disk dislocation. It was successfully replaced with another disk on postoperative day 1. Four patients (4 of 98 = 4%) experienced graft rejection of the donor disk from stopping steroids, but all grafts cleared with restarting of steroids. One patient required surgery for steroid-aggravated glaucoma. In the 5 cases of DLEK surgery in which the clear crystalline lens was left in place, no cataracts were induced at the 6-month postoperative gate. There were no infections, ulcerations, healing defects, or late dislocations. No patient required a contact lens, relaxing incision, or LASIK for residual refractive error.


CONCLUSIONS
DLEK surgery is technically challenging, and yet complications from the surgery in our series were relatively rare and easily resolved. By eliminating sutures and high astigmatism, DLEK surgery avoids the usual complications often associated with transplant surgery.
Terry
Mark A
MA
Devers Eye Institute, 1040 NW 22nd Avenue, Portland, Oregon 97210, USA. mterry@discoveriesinsight.org
Ousley
Paula J
PJ
D000368:Aged; D000369:Aged, 80 and over; D002452:Cell Count; D019781:Corneal Topography; D016039:Corneal Transplantation / Q000009:adverse effects / Q000379:methods*; D004728:Endothelium, Corneal / Q000473:pathology / Q000601:surgery*; D005260:Female; D005642:Fuchs' Endothelial Dystrophy / Q000601:surgery*; D006801:Humans; D015994:Incidence; D007431:Intraoperative Complications; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D011446:Prospective Studies; D016896:Treatment Outcome; D014792:Visual Acuity