Deep lamellar keratoplasty

INTRODUCTION: Deep lamellar keratoplasty (DLKP) is a surgical technique in which the entire corneal stroma is removed down to the Descemet membrane. METHODS: The difference between deep lamellar keratoplasty and classic lamellar keratoplasty is qualitative rather than quantitative. In the first technique, the anatomical cleavage plane provides clear separation of the stroma and the Descemet membrane. This plane has a clear and smooth surface. On the contrary, classic lamellar dissection down to 2/3 of the stroma results in a very rough and uneven surface with a risk of low visual acuity. PURPOSE: To compare the results of 200 cases treated with deep lamellar keratoplasty and 200 cases of penetrating keratoplasty (PK). RESULTS: No rejection episodes were recorded in the 200 patients who underwent DLKP surgery, whereas rejection occurred in 4% of the patients after PK. The number of endothelial cells, measured with a Konan instrument 1 month after removal of the sutures in patients who underwent deep lamellar keratoplasty, was double that in patients who underwent penetrating keratoplasty. CONCLUSION: The number of endothelial cells does not change after DLKP, but is substantially reduced after PK. The degree of astigmatism is greatly reduced and functional recovery is faster with the first technique. These are the main reasons why we think that DLKP could replace PK as the best procedure in all cases in which no endothelial damage is involved.