Enzymatic descemetic lamellar keratoplasty: pilot study.

PURPOSE: This was a pilot study to evaluate the efficacy of a new surgical technique of descemetic anterior lamellar keratoplasty (DALK) with the help of enzymatic hyaluronidase solution.

METHODS

We selected 10 patients, 6 male and 4 female, with surgical keratoconus, with a mean age of 45+/-16 years (range 29-61), with best-corrected visual acuity (BCVA) <or=20/70 logMAR. The study period was from February 1, 2008, to November 3, 2008, at the S. Maria della Scaletta Hospital (Imola, Italy). We evaluated the following parameters preoperatively and postoperatively: BCVA with Snellen card; endothelial density measured by specular microscope (SP 2000P, Topcon, Japan); and mean astigmatism measured by computerized topography (Keratron Scout, Optikon 2000, Rome, Italy). The parameters were evaluated monthly, with a maximum follow-up of 8 months.

RESULTS

There were no perforations and minimal complications (second anterior chamber in 4 eyes) on the first day, which spontaneously resolved after 7 days. Two patients required resuturing because of loose suture on the second postoperative day. The visual recovery was comparable to that obtained by most authors after DALK. The final mean BCVA was 20/25. There was a drop in endothelial cells of approximately 10.1% after 7 months. The mean central astigmatism at the end of the follow-up was 2 diopters (+/-0.88).

CONCLUSIONS

The enzyme application to the recipient cornea makes the stromal dissection easier, but other studies are needed about type and concentration of the enzyme, and the application times.