Endothelial cell density after deep anterior lamellar keratoplasty (Melles technique)

Purpose To measure the recipient endothelial cell loss after the Melles technique for deep anterior lamellar keratoplasty. Methods In 21 eyes of 21 patients, a deep anterior lamellar keratoplasty procedure was performed. Before surgery and at 6, 12, and 24 months after surgery, specular microscopy was performed to evaluate the endothelial cell density. For each postoperative time interval, the mean endothelial cell loss relative to the preoperative value was calculated. Results Mean postoperative endothelial cell loss averaged 283 cells/mm2 (± 293) at 6 months, 335 cells/mm2 (± 309) at 12 months, and 421 cells/mm2 (± 316) at 24 months. Estimate relative endothelial cell density losses obtained by mixed model analysis of variance were 11.1%, 2.0%, and 1.2%, respectively, each time compared with its previous measurement point. Second order comparisons showed that the loss within the first 6 months was significantly higher than after 6 months. Conclusion In deep anterior lamellar keratoplasty, the recipient corneal endothelium showed a small initial drop in endothelial cell density followed by a physiologic rate of cell loss. Cell survival after lamellar keratoplasty may be expected to be better when compared with that following penetrating keratoplasty.

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