Microkeratome and Excimer Laser-Assisted Endothelial Keratoplasty (MELEK)

Introduction: Descemet's stripping automated endothelial keratoplasty (DSAEK) and Descemet membrane endothelial keratoplasty (DMEK) have become well established procedures for the treatment of endothelial pathologies. In the last years the field of lamellar corneal surgery has further developed in terms of preparation of the lamellae as well as of implantation. Patients and Methods: A modified form of the ultrathin DSAEK (UT-DSAEK) is the microkeratome and excimer laser-assisted endothelial keratoplasty (MELEK). In this new technique a corneal graft is prepared by a single cut of a micro-keratome followed by a stromal excimer-laser thinning and smoothing. The purpose of the present report is to describe this new technique and present first clinical results. Results: In this prospective clinical study 18 patients (76 +/- 11 years) underwent a MELEK. The BCVA increased from 0.25 +/- 0.1 preoperatively to one month postoperatively was 0.33 +/- 0.21 (decimal, n = 12), after three months 0.51 +/- 0.23 (n = 8) and after six months 0.80 +/- 0.16 (n = 4). The average thickness of the residual stromal lamella before laser ablation was 173 +/- 42 mu m, after ablation 111 +/- 15 mu m. The central corneal thickness decreased from 704 mu m to 639 mu m, the thickness of the transplant decreased from 114 mu m to 106 mu m six months postoperatively. Conclusion: The ultrathin microkeratome and excimer laser-assisted endothelial keratoplasty (MELEK) is a new and safe technique in the field of lamellar keratoplasty. In the future it could have the potential to combine the advantages of DSAEK and DMEK for the treatment of endothelial pathologies.