Outcomes of Descemet’s stripping endothelial keratoplasty in eyes with failed therapeutic penetrating keratoplasty

Abstract

ABSTRACT.Purpose: To report the results of Descemet's stripping endothelial keratoplasty (DSEK) for failed therapeutic penetrating keratoplasty (PK). Methods: Twenty-seven eyes of 27 patients undergoing DSEK for failed therapeutic PK were analysed. Results: The mean age of the patients was 36 ± 13.9 years (range: 14-70 years).The median size of the therapeutic graft was 10 mm (inter-quartile range; IQR 9.5-11 mm). Descemet's membrane stripping was performed in all eyes. Graft clarity was achieved in 20 ⁄ 27 eyes. Six eyes had primary graft failure, and one had interface keratitis in the early postoperative period. In all eyes with primary graft failure, there was progressive stromal vascularization, which led to haziness in the graft. Late postoperative complications were rejection in four eyes, infection in two eyes, secondary graft failure in one eye and vortex keratopathy in one eye. Graft size was found to be a significant risk factor for graft rejection in this series. At the last follow-up visit, the best-corrected visual acuity was ‡20 ⁄ 40 in 5 ⁄ 27 eyes (18.5%), 20 ⁄ 60-20 ⁄ 40 in 12 ⁄ 27 eyes (44.4%), 20 ⁄ 100-20 ⁄ 60 in 3 ⁄ 27 eyes (1.5%) and £20 ⁄ 200 in 7 ⁄ 27 eyes (25.9%). Conclusions: Considering the limited success of repeat PK in failed large therapeutic keratoplasty, DSEK is a viable option for visual rehabilitation in these eyes, however; visual acuity may be limited due to sub-epithelial ⁄ stromal or interface scarring.

Endothelial Keratoplasty After Failed Penetrating Keratoplasty: An Alternative to Repeat Penetrating Keratoplasty

“…19,20 Initial studies have found graft survival rates of EK under a failed PK to be around 55%-100% at 1 year. [21][22][23] However, many of these studies were noncomparative case series, with a limited follow-up period. 21,[23][24][25][26][27] Of the few studies that examined long-term graft survival, Anshu and associates found a graft survival rate of 74% at 4 years (up to 96% in a subgroup of patients without previous glaucoma shunt surgery).…”

“…[21][22][23] However, many of these studies were noncomparative case series, with a limited follow-up period. 21,[23][24][25][26][27] Of the few studies that examined long-term graft survival, Anshu and associates found a graft survival rate of 74% at 4 years (up to 96% in a subgroup of patients without previous glaucoma shunt surgery). 22 Kitzmann and associates found a trend toward better 3-year graft survival in 7 eyes that underwent EK compared to 17 eyes that had a repeat PK (57.9% vs 68.6%, P ¼ .507), although this result was not statistically significant (likely owing to the small sample size).…”

Outcomes of endothelial keratoplasty in pseudophakic corneal oedema: with or without Descemet's membrane stripping

“…DM stripping was previously considered to be an essential step while performing EK 12. However, a few studies have shown that DM may be left intact especially in cases where DSEK is performed for failed graft,5 post-argon laser iridotomy2 and pseudophakic bullous keratopathy 9. In all these cases, there is no structural damage to DM.…”

“…It was believed that scoring of DM is essential for adherence of the donor lenticule to the stroma of the host 8. There are few studies where EK has been successfully performed without removal of DM in cases of pseudophakic bullous keratopathy,9 failed graft,5 10 corneal decompensation following argon laser iridotomy2 and in few reports of congenital hereditary endothelial dystrophy 4. In this context, we present our prospectively evaluated randomised comparative series of EK with or without stripping DM in patients with PCE.…”

Endothelial keratoplasty versus repeat penetrating keratoplasty after failed penetrating keratoplasty: A systematic review and meta-analysis

“…As an alternative, endothelial keratoplasty (EK) after failed PK has attracted increasing attention [7–13]. In terms of the primary graft, the main advantages of EK over PK include rapid postoperative visual rehabilitation and less allograft rejection [14–19].…”