Deep lamellar endothelial keratoplasty: surgery in complex cases with severe preoperative visual loss
| Autor: | Ashraf F. Amayem, Mark A. Terry, Hazem El-Sabagh, Erfan El-Gazayerli, Magdi Helal, Walid Al Turki, Paula J. Ousley |
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| Rok vydání: | 2005 |
| Předmět: |
Pars plana
Male medicine.medical_specialty Visual acuity genetic structures medicine.medical_treatment Vision Disorders Visual Acuity Vitrectomy Intraocular lens Cell Count Astigmatism Corneal Diseases Corneal Transplantation Lens Implantation Intraocular Ophthalmology Medicine Humans Prospective Studies Aged Lenses Intraocular medicine.diagnostic_test business.industry Ciliary Body Endothelium Corneal Corneal Topography Cataract surgery Middle Aged Corneal topography medicine.disease eye diseases Surgery medicine.anatomical_structure Bullous keratopathy Female sense organs medicine.symptom business |
| Zdroj: | Cornea. 24(5) |
| ISSN: | 0277-3740 |
| Popis: | Purpose This study was designed to report the use of deep lamellar endothelial keratoplasty (DLEK) in combination with other intraocular surgeries in the treatment of eyes with severe bullous keratopathy and visual loss. Methods DLEK surgery was performed in six patients with severe bullous keratopathy and preoperative vision with a range of between count fingers and light perception only. DLEK was combined with vitrectomy and placement of a ciliary sulcus sutured intraocular lens in four patients and with cataract surgery in one patient. Two patients with vitreoretinal disease underwent pars plana vitrectomy within only 4 months after the DLEK donor tissue had been placed. Graft clarity, Snellen visual acuities, refractive astigmatism, endothelial cell counts, and corneal topography were prospectively measured at 6 and 12 months postoperatively. Results At 6 months after DLEK surgery, all grafts were clear and vision improved in all patients. Best spectacle-corrected visual acuity improved from count fingers level (or worse) before surgery to a range of 20/40 to 20/200 after surgery. Average refractive astigmatism at 6 months was 2.0 diopters (range, 0.50-4.00 diopters). The average postoperative endothelial cell count was 1,679 +/- 380 (range, 1,200-2,298) cells/mm at 6 months and 1,449 +/- 365 (range, 1,105-2,043) cells/mm at 12 months. Vitreoretinal surgery subsequent to graft placement did not affect corneal clarity or dislodge the grafted tissue. Conclusions DLEK surgery can be used in cases with severe visual loss caused by bullous keratopathy with transfer of healthy donor endothelium, clearing of the central cornea, and restoration of useful vision. DLEK also can be successfully combined with other intraocular surgeries such as vitrectomy, intraocular lens exchange, and sutured intraocular lens surgery. The DLEK graft can tolerate subsequent intraocular surgery performed as early as 3 months after placement of the donor tissue. |
| Databáze: | OpenAIRE |
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