Descemet stripping automated endothelialkeratoplasty (DSAEK) versus repeat penetrating keratoplasty (PKP) to manage eyes with failed corneal graft.

Abstract

BACKGROUNDFailed corneal graft management is a challenge. Descemet stripping automated endothelial keratoplasty (DSAEK) and repeat penetrating keratoplasty (PKP) are two options. Only two studies have compared outcomes of DSAEK and PKP in the management of a failed graft.OBJECTIVETo compare the visual outcomes, changes in intraocular pressure (IOP) and complications in eyes with failed corneal grafts that were subsequently managed with DSAEK and PKP.DESIGNRetrospective cohort study.SETTINGSTertiary eye hospital of central Saudi Arabia.PATIENTS AND METHODSA retrospective chart review was performed for cases managed between 2007 and 2012. Data were collected on the best-corrected visual acuity (BCVA) before and at day 1, 1 week, 4 weeks, 12 weeks, and 24 weeks after intervention. BCVA was compared in patients managed with DSAEK or PKP. Intra- and postoperative complications were compared in both groups.MAIN OUTCOME MEASURESClear graft, vision at last follow up, complications.RESULTSThere were 15 eyes in the DSAEK group and 30 in the PKP group. The causes of previously failed PKP differed between groups. BCVA at 6 months after repeat surgeries was 20/20 to 20/40 in 4 (27%) eyes in the DSAEK group and in 8 (27%) eyes in the PKP group. The IOP at 6 months was statistically significantly higher in the DSAEK group than the PKP group (P=.006). In DSAEK group, one graft rejection occurred in one eye and graft dislocation in another eye. Seven eyes in PKP group had signs of graft rejection that regressed in 5 eyes following medical management.CONCLUSIONSDSAEK and PKP for previously failed corneal graft resulted in similar BCVA 6 months after repeat surgery. However, the visual outcomes were less promising with both types of surgeries. The lower complication rate and surgical ease may favor DSAEK over PKP in managing failed grafts.LIMITATIONSSmall sample, retrospective study.