title: Visual acuity, refractive error, and endothelial cell density 6 and 12 months after deep lamellar endothelial keratoplasty.
abstract: OBJECTIVE
  To report the visual acuity, refractive outcome, and endothelial cell density (ECD) up to 1 year after deep lamellar endothelial keratoplasty (DLEK) in a large prospective series.
  
  
  METHODS
  Eighty-six DLEK procedures were performed and evaluated in a prospective interventional case series. Subgroup analysis was performed to compare results from large-incision (9 mm) DLEK (n = 7), small-incision (5-8 mm) DLEK (n = 70), and penetrating keratoplasty (PKP) conversion (n = 9). Outcome measures included best-corrected visual acuity (BCVA), manifest refraction, corneal topographic astigmatism, and ECD.
  
  
  RESULTS
  The percentage of eyes that achieved a BCVA of 20/40 or better after DLEK was 55% at 6 months, increasing to 61% at 1 year. Topographic astigmatism and spherical equivalent were not significantly different than preoperative measurements up to 1 year after DLEK (P > 0.05). An endothelial cell loss of 40% at 6 months and 48% by 1 year was observed. The mean ECD after DLEK was 1831 +/- 472 cells per square millimeter at 6 months and 1569 +/- 601 cells per square millimeter at 12 months. When evaluated by incision size, the ECD was better at 2066 +/- 558 cells per square millimeter with a 9-mm incision compared with only 1516 +/- 585 cells per square millimeter with a smaller incision at 1 year, although this did not reach significance (P = 0.075). The endothelial cell loss after penetrating keratoplasty conversion was similar to that in the large-incision group (P > 0.05).
  
  
  CONCLUSIONS
  DLEK provides good visual acuity (> or =20/40) for the majority of patients at 1 year with stable refractive error compared with baseline. Refractive stability was observed with both large- and small-incision DLEKs; however, worrisome endothelial cell loss was observed, especially with a small-incision technique.
authors.affiliation: Department of Ophthalmology & Visual Sciences, University of Iowa, Iowa City, IA, USA.
authors.forename: Parley D
authors.initials: PD
authors.lastname: Fillmore
authors.forename: John E
authors.initials: JE
authors.lastname: Sutphin
authors.forename: Kenneth M
authors.initials: KM
authors.lastname: Goins
mesh_terms: D001251:Astigmatism / Q000209:etiology / Q000503:physiopathology; D002452:Cell Count; D055954:Corneal Endothelial Cell Loss / Q000209:etiology / Q000473:pathology; D019781:Corneal Topography; D057111:Descemet Stripping Endothelial Keratoplasty; D004728:Endothelium, Corneal / Q000473:pathology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D011183:Postoperative Complications; D011446:Prospective Studies; D012029:Refraction, Ocular / Q000502:physiology; D012030:Refractive Errors / Q000209:etiology* / Q000503:physiopathology; D014792:Visual Acuity / Q000502:physiology*