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Five-Millimeter-Incision Deep Lamellar Endothelial Keratoplasty: One-Year Results

Purpose: To evaluate visual acuity, topography, and endothelial cell density 1 year after deep lamellar endothelial keratoplasty (DLEK) for endothelial dysfunction. Methods: This is a prospective, comparative, interventional case series. Thirty-five eyes of 35 patients who had undergone DLEK with a 5-mm incision and had a minimum of 1-year follow-up were included. Main outcome measures were best spectacle-corrected visual acuity (BSCVA), uncorrected visual acuity (UCVA), astigmatism, topographic regularity and symmetry, and endothelial cell density. Results: One year postoperatively, BSCVA was 0.33 ± 0.12 (mean, 20/60; range, 20/40-20/400) compared with 0.15 ± 0.15 preoperatively (mean, 20/200; range, 20/70-20/800). Six patients did not reach an acceptable visual acuity and were not included in the mean BSCVA, 2 had a primary failure, and the others had preexisting glaucoma or macular disease. Spherical equivalent was -0.04 ± 1.2 D, refractive astigmatism was 1.76 ± 1.69 D, surface regularity index was 0.97 ± 0.54, and surface asymmetry index was 1.25 ± 0.78 1 year after surgery. Mean endothelial cell count from the donor was 2904 ± 559 (range, 4694-2111) and 1 year after surgery was 1595 ± 662 (range, 702-3040), equating to 45% cell loss (range, 15%-77%). Conclusions: DLEK is a newer method to replace the endothelium in patients with Fuchs dystrophy. Results showed minimal astigmatism, good topographic parameters, and acceptable visual acuity. Endothelial cell loss at 1 year was significant.