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 replacing diseased corneal endothelium while minimizing visual recovery time. DESIGN: Noncomparative, prospective, clinic-based, interventional case series. PARTICIPANTS: A total of seven patients with aphakic bullous keratopathy (n = 2), pseudophakic bullous keratopathy (n = 4), or Fuchs' corneal dystrophy (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 underlying 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 nylon suture. In the two most recently operated patients, anterior lamella, 160 microm in thickness, was removed from the donor button before transplantation. MAIN OUTCOME MEASURES: Visual acuity, refraction, keratometry, corneal topography. RESULTS: All corneas were clear, and the surface reepithelialized within 4 weeks after surgery. Regular astigmatism of less than 4 diopters was recorded in all cases as early as 4 weeks after surgery. Epithelial interface ingrowth with extensive melting of the corneal flap was observed in one patient 3 months after surgery and was managed by removal of the flap and resuturing of the donor button. CONCLUSIONS: Endokeratoplasty represents a promising alternative to conventional penetrating keratoplasty for patients with diseased corneal endothelium.