Endokeratoplasty as an alternative to penetrating keratoplasty for the surgical treatment of diseased endothelium - Initial results

Purpose: To test the feasibility of a new surgical technique aimed at repla cing diseased corneal endothelium while minimizing visual recovery time. Design: Noncomparative, prospective, clinic-based, interventional case seri es. Participants: A total of seven patients with aphakic bullous keratopathy (n = 2), pseudophakic bullous keratopathy (n = 4), or Fuchs' corneal dystroph y (n = 1) participated. Intervention: All patients underwent a surgical procedure including removal of the epithelium, creation of a 9.5-mm corneal flap, substitution of an u nderlying 6.5-mm button of deep stroma and endothelium with a 7.0-mm donor button, and suturing of the flap back into position using a 10-0 running ny lon suture, In the two most recently operated patients, anterior lamella, 1 60 mum in thickness, was removed from the donor button before transplantati on. Main Outcome Measures: Visual acuity, refraction, keratometry, corneal topo graphy. Results: All corneas were clear, and the surface reepithelialized within 4 weeks after surgery. Regular astigmatism of less than 4 diopters was record ed in all cases as early as 4 weeks after surgery. Epithelial interface ing rowth with extensive melting of the corneal flap was observed in one patien t 3 months after surgery and was managed by removal of the flap and resutur ing of the donor button. Conclusions: Endokeratoplasty represents a promising alternative to convent ional penetrating keratoplasty for patients with diseased corneal endotheli um, Ophthalmology 2000;107.2077-2082 (C) 2000 by the American Academy of Op hthalmology.