Deep lamellar endothelial keratoplasty: up to 5-year follow-up.

Purpose To evaluate the outcomes of small-incision deep lamellar endothelial keratoplasty (DLEK) for the treatment of endothelial dysfunction at up to 5 years of follow-up. Design Prospective, noncomparative case series. Participants Sixty eyes of 55 consecutive patients who had corneal edema as a result of Fuchs' dystrophy, pseudophakic bullous keratopathy, bullous keratopathy secondary to glaucoma tube placement, failed graft, or deep endothelial scar. Methods Patients underwent DLEK surgery at the Toronto Western Hospital. Main Outcomes Measures Best spectacle-corrected visual acuity (BSCVA), manifest refraction, corneal endothelial cell density (ECD), and postoperative complications. Results Data were available for 57, 49, 46, 23, and 7 eyes for examination at 1, 2, 3, 4, and 5 years, respectively. The mean spherical equivalent and refractive astigmatism were −0.18±1.62 diopters (D) and 1.67±1.36 D, respectively, at 1 year after surgery and remained stable at 2, 3, and 4 years after DLEK. Eliminating eyes with known significant macular or optic nerve disease, BSCVA of 20/188.5 before surgery improved to 20/56.9 at 1 year after surgery ( P = 0.0002) and remained stable with BSCVA of 20/52.3, 20/46.2, and 20/56.8 at 2, 3, and 4 years, respectively, ( P = 0.59, P = 0.31, P = 0.24, respectively). The number of patients who achieved 20/40 or better visual acuity, increased from a preoperative level of 13.5% to 44.1%, to 40%, to 48.4%, and to 50% at 1, 2, 3, and 4 years after surgery, respectively. The mean donor ECD before surgery was 2762±536 cells/mm 2 and decreased by 43% at 1 year after surgery (1604±787 cells/mm 2 ; P 2 ; P = 0.03), by 4% (1136±613 cells/mm 2 ; P = 0.41), and by 1% (1064±515 cells/mm 2 ; P = 0.68) was found at 2, 3, and 4 years, respectively. Complications included 4 graft dislocations, 2 primary graft failures, 5 rejections, and 12 secondary failures, with 27.5% graft failure at 4 years. Conclusions Small-incision DLEK provides good and stable refractive and visual outcomes. The accelerated endothelial cell loss reported during the first 2 years after DLEK was shown to decrease and stabilize at low rates during the longer-term follow-up, which reduces the concern about progressive cell loss and secondary late endothelial failure. Financial Disclosure(s) The author(s) have no proprietary or commercial interest in any materials discussed in this article.