Deep Lamellar Endothelial Keratoplasty
With Femtosecond Laser (Intralase)

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, Descement's layer. 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.

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.

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.

The femtosecond laser was developed for creation of All-Laser 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.

If you are ready to choose a doctor to be evaluated for conventional or custom wavefront Lasik, All-Laser Lasik, PRK, LASEK, Epi-Lasik, CK, RLE, or any refractive surgery procedure, we highly recommend you consider a doctor who has been evaluated and certified by the USAEyes nonprofit organization. Locate a USAEyes Evaluated & Certified Lasik Laser Eye Surgery Doctor.