In pursuit of emmetropia - Spherical equivalent refraction results with deep lamellar endothelial keratoplasty (DLEK)

Purpose: To determine if the new technique for endothelial transplantation of DLEK (deep lamellar endothelial keratoplasty) can offer predictable corneal curvature and improved refractive spherical equivalent results compared with reports for traditional penetrating keratoplasty. Methods: Twenty-seven consecutive Fuchs corneal dystrophy patients received DLEK surgery to replace their endothelium. Topographic corneal curvature and refractive spherical equivalents were evaluated at preop and at 6 and 12 months postop. Results: At 6 months (n = 27) the average corneal curvature was 43.8 +/- 1.4 D, representing a mean change from preop corneal curvature of only -0.1 +/- 1.7 D. At 12 months (n = 18) the average corneal power was 43.5 +/- 1.7 D. The average corneal curvature at 6 and 12 months was not significantly different from pre-op (P = 0.119). The average refractive spherical equivalent result at 6 months was -0.44 +/- 1.7 D, and at 12 months was -0.44 +/- 1.6 D. The 6- and 12-month refractive spherical equivalent results were not statistically different from the preop spherical equivalent refractions (P = 0.922). All patients could be easily refracted, and several patients were fit with stable glasses as early as 3 months after DLEK surgery. Conclusion: DLEK surgery preserves the preoperative corneal curvature and therefore allows better matching of postop corneal curvature to the 101, power. This increase in predictability of the postoperative corneal curvature makes the choice of 101, power for the new "triple procedure" more accurate, eliminates the need for contact lens wear after PK, and provides earlier visual rehabilitation after endothelial replacement.