Descemet Membrane Endothelial Keratoplasty After Penetrating Keratoplasty: Features for Success

Abstract

DMEK is a viable option for cases of failed PKP. DMEK failure after PKP might be associated with lower visual acuity before DMEK surgery, higher number of rebubble interventions, and manual descemetorhexis rather than femtosecond laser-enabled DMEK.

Long‐term outcome of descemet membrane endothelial keratoplasty (DMEK) following failed penetrating keratoplasty (PK)

“…1). This observation was also made by other authors (Gundlach et al 2015;Einan-Lifshitz et al 2018;Pierne et al 2019).…”

“…Compared to other studies, we report an acceptable survival rate of 65.4% after two and a half years. Einan‐Lifshitz et al (2018) reported a survival rate of 57% after 3 years, Pasari et al (2019) 80% after 3 years and 76% after 4 years. Possible explanations for the low graft survival rate in our cohort may include (i) the complex initial situation in most eyes (e.g.…”

“…Pasari et al (2019) reported 2019 in a larger cohort ( n = 93) ECD loss rates of 31% at 6 months, 44% at one year and 47% at two years. Einan‐Lifshitz et al reported a ECD loss of 41% at 6 months and 48% at one year ( n = 28) (Einan‐Lifshitz et al 2018). As previously described in other studies, the increased endothelial cell loss compared to DMEK transplantation in healthy eyes may be explained through the additional manipulation for centring the graft due to irregular wound margins (Pasari et al 2019).…”

Preoperative Evaluation in Descemet Membrane Endothelial Keratoplasty for Secondary Penetrating Keratoplasty Graft Failure

“…Visual recovery and central pachymetry improvement were relatively fast during the study period (Table 2). Those favorable clinical outcomes are consistent with other studies as well [16,18,22]. The visual recovery with DMEK under failed PK contrasts sharply with the delayed and unpredictable visual rehabilitation after re-PKP [29].…”

“…Common conclusions have emerged from multiple previous studies regarding the results of DMEK after PKP compared to primary DMEK [16,18,19,22,23], including higher rebubbling rates, higher endothelial cell density loss, higher late graft failure rates and more demanding surgical technique. Furthermore, glaucoma ltering surgeries, which are probably more prevalent in post-PKP eyes, are considered a signi cant risk factor for late graft failure, probably as a result of altering the microenvironment in the aqueous humor which accelerates endothelial cell loss [24].…”