Secondary Descemet Membrane Endothelial Keratoplasty After Failed Primary Descemet Membrane Endothelial Keratoplasty

Abstract

To evaluate the clinical outcome of a secondary Descemet membrane endothelial keratoplasty (DMEK) to manage graft failure after primary DMEK. Retrospective analysis of graft failure after primary DMEK treated with a second DMEK. The clinical outcome was evaluated by comparing the pre- to postoperative best-corrected visual acuity (BCVA) after first and second DMEK. In 122 DMEKs performed, 6 patients were included because of nonclearing edema or graft detachment. Ten of 122 grafts failed, 8 had a second DMEK, and 6 had an adequate follow-up with visual potential to be included in the visual acuity analysis. All patients had Fuchs dystrophy as the underlying disease for the endothelial decompensation. Average time to the second surgery was 2.9 months (1-5 months). Mean follow-up after second DMEK was 3.3 months (1-6 months). BCVA was 0.63 ± 0.22 logarithm of the minimum angle of resolution (logMAR) preoperatively and decreased to 1.50 ± 0.28 logMAR after first surgery (mean follow-up, 2.9 months; P < 0.001). BCVA increased to 0.13 ± 0.05 after successful second DMEK (mean follow-up, 3.3 months; P < 0.001). All second DMEKs were successful. To manage DMEK cases with graft failure, secondary DMEK may be a feasible procedure potentially resulting in full visual rehabilitation, as in primary DMEK. In the event of a DMEK graft failure, a secondary DMEK may be an effective back-up procedure because it may give a clinical outcome similar to that given after a primary DMEK.