Deep Lamellar Endothelial
Keratoplasty (DLEK) is an endothelial cell transplant technique developed to allow transplant
of the corneal endothelial cell layer and its basement membrane, also known as the Descement's layer.
Alternative to Transplant
DLEK is an alternative to PKP, which requires the full thickness of the cornea to be replaced.
PKPs are no fun, having a long vision recovery period, and are not terribly
predictable.
Corneal Distress
Endothelial distress
is a leading cause of the need for a corneal transplant. The primary
problem is endothelial cell dystrophy (Fuch's Dystrophy), or endothelial
cell loss from P-IOL, during cataract surgery or RLE, trauma to the eye, and other disease.
When the endothelial
cells become compromised, a transplant can often resolve the problem.
Unfortunately, transplanting just the endothelial layer and Decement's
on the underside of the cornea inside the eye is not exactly easy.
Transplant Just Endothelium
DLEK is an endothelial
cell transplant technique wherein a disk of endothelial cell tissue
is removed from a donor cornea and placed on the underside of the recipient
cornea, replacing a disk of endothelial cell tissue of equal size that
has been removed from the recipient. Development of DLEK using mechanical
scalpels and customized cutting tools works, but tends to create a very
uneven transplant with poor adhesion. The disk can be created with a
mechanical device, or with the femtosecond laser microkeratome.
Femtosecond Laser
The femtosecond laser
was developed for creation of Bladeless Lasik flaps, but is finding uses in many other areas. The femtosecond
makes DLEK much more predictable with a faster vision recovery time.
From the front side
of the cornea, the laser creates a lamellar incision deep in the recipient's
cornea just anterior to Descement's. When this circular incision is
complete, the laser then cuts the sides by making incision from the
level of the lamellar incision back through the bottom of the cornea.
This creates a disk of just Decement's and endothelium in a very precise
form - within about 10 microns of desired size.
The laser then creates
an identical disk from donor tissue using the same process. The recipient's
disk is rolled up and removed through a relatively small (by PKP standards,
anyway) 5.0mm incision at the edge of the cornea, and the donor disk
is rolled up, placed inside the eye through the same incision created
to remove the bad endothelium layer, and then is unfolded and fitted
into the "hole" created by the removal of the recipient's disk.
The cornea's natural
"suction" holds the disk in place without sutures or biological glues.
Looking For Best Lasik Surgeon?
If you are ready to choose a doctor to be evaluated for conventional
or custom wavefront Lasik, Bladeless Lasik, PRK, or any refractive surgery procedure, we recommend you consider a doctor who has been evaluated and certified by the USAEyes nonprofit organization.
Locate a USAEyes Evaluated & Certified Lasik Doctor.
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