II.2.c Small incision posterior lamellar keratoplasty / deep lamellar endothelial keratoplasty (PLK/DLEK)(small incision PLK/DLEK)

Topic II.2.c – Posterior lamellar keratoplasty / ‘small incision’ deep lamellar endothelial keratoplasty (PLK/small incision DLEK)

In 1998, the NIIOS PLK/DLEK procedure was refined. Instead of using a 9.0 scleral incision, the technique was modified such that it could be performed through a 5.0 mm incision. A smaller incision bears less risk of intraoperative complications and it further reduced postoperative astigmatism. This posterior lamellar keratoplasty technique was popularized as ‘Small incision deep lamellar endothelial keratoplasty (small incision DLEK). Both techniques have been employed by leading corneal surgeons throughout the world from 2000 until 2004.

Prior art

• To the best of our knowledge: None.

NIIOS Contributions

• Melles GRJ, Lander F, Nieuwendaal CP: Sutureless posterior lamellar keratoplasty. Cornea 2002;21:325-327.
• Melles GRJ: Editorial on posterior lamellar keratoplasty. Arch Soc Esp Oftalmol 2002;77:175-176.
• Alio JL, Shah S, Barraquer C, Bilgihan K, Anwar M, Melles GRJ: New techniques in lamellar keratoplasty. Current Opin Ophthalmol 2002;13:224-229.
• Melles GRJ. An Alternative to Penetrating Keratoplasty. Review of Ophthalmology 2004.
• Melles GRJ. An Alternative to Penetrating Keratoplasty. Review of Ophthalmology en Espanol 2004.
• Dooren van BTH, Mulder P, Nieuwendaal CP, Beekhuis WH, Melles GRJ: Endothelial cell density after posterior lamellar keratoplasty (Melles technique); 3 years follow-up. Am J Ophthal 2004;138:211-217.

Parallel developments

• To the best of our knowledge: None.

Spin off

• Seitz B, Langenbucher A, Hofmann-Rummelt C, Schlotzer-Schrehardt U, Naumann GO. Nonmechanical posterior lamellar keratoplasty using the femtosecond laser (femto-plak) for corneal endothelial decompensation. Am J Ophthalmol 2003;136:769-772.
• Terry MA, Ousley PJ. Small-incision deep lamellar endothelial keratoplasty (DLEK): six-month results in the first prospective clinical study. Cornea 2005;24:59-565.
• Terry MA, Ousley PJ. Deep lamellar endothelial keratoplasty visual acuity, astigmatism, and endothelial survival in a large prospective series. Ophthalmology 2005;112:1541-1548.
• Fogla R, Padmanabhan P. Initial results of small incision deep lamellar endothelial keratoplasty (DLEK). Am J Ophthalmol 2006;141:346-351.
• Faia LJ, Baratz KH, Bourne WM. Corneal graft folds: a complication of deep lamellar endothelial keratoplasty. Arch Ophthalmol 2006;124:593-595.
• Lang GK. Lamellar kreatoplasty - new concepts. Klin Monatsbl Augenheilkd 2004;221:13.
• Duncker GI, Krumeich J, Wilhelm F, Bredehorn T. Lamellar keratoplasty - new concepts. Klin Monatsbl Augenheilkd 2004;221:14-23.
• Yeh PC, Azar DT, Colby K. Selective endothelial transplantation: novel surgical techniques for the treatment of endothelial dysfunction. Int Ophthalmol Clin 2004;44:51-66. Review.
• Nguyen A, Azar D. Lamellar keratoplasty revisited. Int Ophthalmol Clin 2004;44:83-91. Review.
• Terry MA, Ousley PJ, Will B. A practical femtosecond laser procedure for DLEK endothelial transplantation: cadaver eye histology and topography. Cornea 2005;24:453-459.
• Soong HK, Mian S, Abbasi O, Juhasz T. Femtosecond laser-assisted posterior lamellar keratoplasty: initial studies of surgical technique in eye bank eyes. Ophthalmology 2005;112:44-49.

Copyright NIIOS©2006