Rapid visual rehabilitation after endothelial transplants with deep lamellar endothelial keratoplasty (DLEK)

Objective: To evaluate the speed of visual recovery in 30 consecutive patients with Fuchs endothelial dystrophy who received deep lamellar endothelial keratoplasty (DLEK) transplant surgery. Methods: Best spectacle-corrected visual acuity (BSCVA) by manifest refraction and uncorrected visual acuity (UVA) were prospectively measured at preop, at 1 week, and at 1, 3, 6, 12, and 18 months after DLEK. The LogMAR of the postop vision was compared against each patient's preop vision. Visual results at 6 months were also compared against potential acuity meter (PAM) results in 27 patients. All eyes had reached at least the 6-month follow-up interval. Results: Two of the first 32 eyes originally enrolled in the protocol were converted at surgery to standard penetrating keratoplasty (PK), and so DLEK data were obtained on 30 eyes for this report. Average BSCVA and UVA were better than preop vision at every time point, achieving statistical significance by 3 months (P < 0.05). Average preop BSCVA was 20/162 (range 20/40 to CF), improving to 20/63 at 3 months (range 20/25 to 20/200), 20/56 at 6 months, 20/51 at 1 year, and 20/46 at 18 months. of the 27 patients who had PAM testing, 52% (14 of 27) had BSCVAs within 1 line of their PAM at 3 months, 63% (17 of 27) were within 1 line at 6 months, 71% (12 of 17) were within 1 line at 1 year, and 83% (10 of 12) were within 1 line at 18 months (P < 0.05 compared with preop from 3 months on). Conclusion: DLEK surgery preserves the normal corneal surface topography and allows rapid visual recovery of useful vision by 3 months. The visual acuity continues to improve over time.