Comparison of Deep Lamellar Endothelial Keratoplasty and Penetrating Keratoplasty in Patients With Fuchs Endothelial Dystrophy

Abstract

To evaluate and compare 1-year postoperative visual acuity, refractive results, endothelial cell density (ECD), and complications in a consecutive group of patients who underwent deep lamellar endothelial keratoplasty (DLEK) with those who underwent penetrating keratoplasty (PK) performed by 1 surgeon. We prospectively analyzed results of 20 consecutive patients with Fuchs dystrophy and pseudophakia who underwent small-incision DLEK surgery and retrospectively compared these results with those of 23 consecutive patients with Fuchs dystrophy and pseudophakia who underwent standard PK surgery during the same period. Main outcome measurements were best spectacle-corrected visual acuity (BSCVA); refractive, keratometric, and topographic astigmatism; topographic irregular astigmatism; absolute change in spherical equivalent; and ECD. Postoperative complications in the 2 groups were also analyzed. Preoperative BSCVA was significantly better in the DLEK group than the PK group (P = 0.013). Postoperative BSCVA was significantly better in the DLEK group than the PK group at 6 months (P = 0.025) and similar in each group at 12 months. Twelve-month postoperative refractive, keratometric, and topographic astigmatism was significantly less in the DLEK group than the PK group (P < 0.001). Surface asymmetry index and change in keratometric spherical equivalent was significantly less in the DLEK group than the PK group at 12 months postoperatively (P < 0.001). Preoperative ECD was significantly higher in the DLEK group (3072 +/- 307 cells/mm) than the PK group (2779 +/- 413 cells/mm). Twelve-month postoperative ECD was similar in the DLEK group (1293 +/- 469 cells/mm) compared with the PK group (1303 +/- 454 cells/mm; P = 0.949, not significant). Twelve-month percent endothelial cell loss was higher than reported in previous studies but was similar in the DLEK group (57.9%) compared with the PK group (53.1%). Twelve months postoperatively, all grafts were clear in the DLEK and PK groups. DLEK surgery resulted in more rapid vision recovery, significantly less regular and irregular astigmatism, and less change in spherical equivalent than PK surgery. Endothelial cell loss was significant in both groups but was not significantly different in the DLEK group from the PK group. DLEK surgery has significant advantages over PK surgery, but long-term ECD and graft survival in DLEK surgery should be studied.