Applying of deep lamellar keratoplasty in the corneal disorders without endothelial abnormalities

Introduction
To present own experiences in the surgery of deep lamellar keratoplasty.

Material and methods
25 eyes of 25 patients suffering from various corneal pathologies with preserved endothelium: 22 with keratoconus eyes, 2 with post-inflammatory scar and one eye with leucoma in Stevens-Johnson syndrome. Mean follow-up was 25,5 months (from 6 to 32). Main outcome measures were Non-Corrected and Best Corrected Visual Acuity (NCVA, BCVA), astigmatism, refractive error, IOP and corneal transparency. The surgery was performed in general anesthesia. In majority of cases the recipient stroma was trephined to a depth of 70% with 7,5 mm diameter vacuum trephine. In cases of intraoperative perforation of Descemet membrane with shallow anterior chamber we converted the procedure into penetrating keratoplasty. The donor lenticule was trephined in the artificial chamber with the 0,5 mm oversized manual trephine to a depth of 90%. In two cases after DLK was finished, limbal stem cell grafting was additionally performed.

Results
Postoperative NCVA ranged from 0,01 to 0,8 and BCVA from 0,1 to 0,8. Astigmatism ranged from 0,5 to 10,0 D. Refractive error ranged from -8,0 to +1,0 D. In follow-up period all grafts maintened transparent. The complications were mainly intraoperative perforations of Descemet membrane (9 cases): in 7 cases we convert the procedure into penetrating keratoplasty. In 2 cases the double chamber forming was observed: in one case on 7 day following surgery the penetrating keratoplasty was performed, in other a spontaneous attachment was observed. We also observed loose sutures in 2 cases, inflammatory infiltrates in one case. Two cases of ocular hypertension was successfully treated by medication.

Conclusions
Deep lamellar keratoplasty is an effective procedure for treating various diseases of corneal stroma with unaffected endothelium.