Preliminary outcome of large-diameter lamellar keratoplasty combined with deep lamellar endothelial keratoplasty for whole cornea destruction

Abstract

To understand the indication, surgical principle, outcome and complications of large-diameter lamellar keratoplasty combined with deep lamellar endothelial keratoplasty for whole cornea destruction. Eleven hospitalized patients with whole cornea destruction in Zhongshan Ophthalmic Center, Sun Yat-Sen University from May, 2005 to March, 2006 were involved in this study. Five left eyes and six right eyes underwent large-diameter lamellar keratoplasty combined with deep lamellar endothelial keratoplasty. The patients were followed up for 12 to 18 months and their pinhole postoperative visual acuity, intraocular pressure, pachymetry of the central cornea and corneal endothelial cell density was recorded. The pinhole postoperative visual acuity of all patients improved and averaged separately 4.4 +/- 0.3, 4.5 +/- 0.3 and 4.5 +/- 0.3 at the 3rd, 6th and 12th postoperative month. There was a temporary increase of the postoperative intraocular pressure within one postoperative week which can be controlled by medication and released soon. And the postoperative intraocular pressure averaged (19.8 +/- 2.7), (19.2 +/- 1.7) and (19.5 +/- 2.0) mm Hg respectively at the 3rd, 6th and 12th month postoperatively. At the same following up times, the pachymetry of the central cornea averaged (538.9 +/- 8.9), (536.3 +/- 6.3) and (537.2 +/- 6.9) microm respectively and the corneal endothelial cell density averaged (2519.8 +/- 110.7), (2244.4 +/- 137.9) and (2093.3 +/- 141.9) cells/mm2 respectively. The main complication was the interspace between the two lamellar grafts and it would disappear automatically within one postoperative month. Large-diameter lamellar keratoplasty combined with deep lamellar endothelial keratoplasty can avoid postoperative glaucoma. It may offer further advantages over traditional surgery to treat whole cornea destruction.