Abstract

FR.13.04

Posterior lamellar keratoplasty – Berlin results

Peter W. Rieck
Augenklinik, Campus Virchow Klinikum, Charité - Universitätsmedizin Berlin, Berlin

Objective: The technique of posterior lamellar keratoplasty is an interesting option especially for diseases of the corneal endothelium. The main problems of perforating keratoplasty, i.e. prolonged visual recovery, high astigmatism or anisometropia with subsequently reduced binocular function are avoided when only the endothelial sheet is replaced, since the ocular surface remains undisturbed.
Methods: The surgical technique of this relatively new technique has been considerably refined during the last years. In the recipient eye, the so-called descemet stripping (DSEK) approach has gained overall acceptance. We report on the surgical results of 25 patients that had been operated on in our center with a modified no stitch DSEK technique because of a decompensated Fuchs endothelial dystrophy.
Results: The mean pre-op. BSCVA was 0.1. 6 months postoperatively, BSCVA was 0.5. Endothelial cell loss was 30±8% after 6 months. In 3 cases (out of the first 10 cases) a primary transplant decompensation was noticed. A dislocation of the posterior lamella occured in 2 patients, In one case, an uncertain immune reaction appeared but the transplant recovered after topical steroid treatment.
Conclusions: The main advantages of posterior lamellar keratoplasty are rapid visual recovery and gentle procedure compared to perforating keratoplasty. Remaining problems are the high endothelial cell loss as well as the still limited BCVA.

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