Descemet Membrane Endothelial Keratoplasty as Treatment for Graft Failure After Descemet Stripping Automated Endothelial Keratoplasty

Abstract

To investigate the outcome of Descemet membrane endothelial keratoplasty (DMEK) in patients with graft failure after Descemet stripping automated endothelial keratoplasty (DSAEK). Retrospective cohort study. setting: Institutional. Fifteen eyes of 15 patients that underwent DMEK for graft failure with corneal decompensation following DSAEK were analyzed; 15 eyes with primary DMEK for Fuchs corneal dystrophy were included as control group. Best-corrected visual acuity (BCVA), endothelial cell density (ECD), central corneal thickness (CCT), and rebubbling rate. DMEK surgery was successful in all cases of both groups. Mean BCVA (logMAR) before DMEK was 1.27 ± 0.34 in the DMEK after DSAEK group and 1.0 ± 0.40 in the Primary DMEK group. After DMEK, mean BCVA increased significantly to 0.23 ± 0.21 (P= .012, DMEK after DSAEK group) and 0.29 ± 0.23 (P= .042, Primary DMEK group) after 3months. There were no significant differences in mean BCVA between both groups at each visit. The rebubbling rate was 13% in the DMEK after DSAEK group and 40% in the Primary DMEK group (P= .1). Mean CCT decreased significantly in both groups 1month after DMEK (P < .05). Mean ECD and change of ECD did not differ significantly between both groups at each visit (P > .05). The results after DMEK as a procedure to treat graft failure after DSAEK were as good as in patients that underwent DMEK as primary intervention to treat advanced Fuchs dystrophy. This indicates that the optical quality can be reestablished by DMEK in patients with failed DSAEK.