Repeat Penetrating Keratoplasty Research Articles

Clinical Outcomes in Patients With Traumatic Dehiscence of Penetrating Keratoplasty Grafts.

The purpose of this study was to report clinical characteristics and outcomes of surgical repair for patients with traumatic dehiscence of penetrating keratoplasty (PKP) grafts. Retrospective, consecutive chart review of patients evaluated at Bascom Palmer Eye Institute between 2015 and 2020 with traumatic dehiscence of penetrating keratoplasty grafts. The study cohort consisted of 65 eyes of 65 patients. The mean age at presentation was 72 years (SD 18), with a male predominance (65%). The most common indications for PKP included keratoconus (42%), corneal scar (31%), and Fuchs corneal dystrophy (8%). Dehiscence occurred as a result of blunt trauma in 94% of cases, and the mean wound length was 6.4 clock hours (SD 2.4), with a predominance of inferior dehiscence. The mean presenting visual acuity (VA) was 2.45 logMAR (SD 0.41), and the mean final VA was 2.17 logMAR (SD 0.99). Graft failure occurred in 64% of patients, and 22% underwent repeat PKP. When stratified by indication for corneal transplantation (keratoconus vs. other), there was no significant difference in graft age at the time of rupture, final VA, rate of graft failure, or rate of repeat PKP. Traumatic dehiscence of corneal grafts remains a rare but serious subtype of ocular trauma with generally poor visual prognoses. Presenting VA along with severity of trauma and posterior segment involvement tend to be the worst prognostic factors in final visual outcome.

Comparison of repeat penetrating keratoplasty, DSAEK and DMEK for the management of endothelial failure of previous PK

PurposeTo compare the clinical outcomes of repeat PK, DSAEK-on-PK or DMEK-on-PK for the management of endothelial failure of previous penetrating keratoplasty.DesignRetrospective, interventional consecutive case series.Participants104 consecutive eyes of 100 patients requiring a second keratoplasty for endothelial failure of their primary penetrating keratoplasty performed between September 2016 and December 2020.InterventionRepeat keratoplasty.Main outcome measuresSurvival and visual acuity at 12 and 24 months, rebubbling rate and complications.ResultsRepeat PK was performed in 61/104 eyes (58.7%), DSAEK-on-PK was performed in 21/104 eyes (20.2%) and DMEK-on-PK was performed in 22/104 eyes (21.2%). Failure rates in the first 12 and 24 months were 6.6% and 20.6% for repeat PKs compared to 19% and 30.6% for DSAEK and 36.4% and 41.3% for DMEK. For those grafts surviving 12 months, the chances of surviving to 24 months were greatest for DMEK-on-PK at 92% vs 85% each for redo PK and DSAEK-on-PK. Visual acuity at one year was logMAR 0.53 ± 0.51 in the redo PK group, 0.25 ± 0.17 for DSAEK-on-PK and 0.30 ± 0.38 for DMEK-on-PK. 24-month outcomes were 0.34 ± 0.28, 0.08 ± 0.16, and 0.36 ± 0.36 respectively.ConclusionsDMEK-on-PK has a greater failure rate in the first 12 months than DSAEK-on-PK which has a greater failure rate than redo PK. However, the 2-year survival rates in our series for those already surviving 12 months were greatest for DMEK-on-PK. There was no significant difference in visual acuity at 12 or 24 months. Careful patient selection is needed by experienced surgeons to determine which procedure to offer to patients.

Clinical Analysis of Repeat Penetrating Keratoplasty in Children.

(1) Background: To analyze the indications, graft survival, and graft failure-related risk factors of repeat penetrating keratoplasty (RPK) in children. (2) Methods: In this case series, children younger than 12 years who received RPK at Beijing Tongren Hospital were reviewed. The indications for RPK, postoperative complications, and graft survival were analyzed. The analysis of the potential variables associated with graft survival was performed using Cox proportional hazards regression. (3) Results: A total of 30 RPK eyes of 29 children were included in this study. The mean follow-up time was 26.98 ± 18.75 months. The most common indication for RPK was a vascularized corneal scar (86.67%). Postoperative complications occurred in 27 eyes (90%), including immune rejection (46.67%), epithelial defects (36.67%), and glaucoma (26.67%). About 60% of the regrafts remained clear one year after RPK, while the overall graft survival rate was 30% at the last visit. The most common cause of regraft failure was irreversible immune rejection (8/21). The significant risks of graft failure included an age of less than 60 months at surgery (p = 0.009), corneal vascularization (p = 0.018), and a postoperative epithelial defect (p = 0.037). (4) Conclusions: A vascularized corneal scar is the most common indication of RPK in children. Immune rejection is the most prevalent complication, and irreversible immune rejection always causes regraft failure.

Epstein-Barr Virus Keratouveitis-Induced Malignant Glaucoma After Penetrating Keratoplasty: A Case Report and Literature Review

ABSTRACT Purpose To report a case of Epstein-Barr virus (EBV) keratouveitis-induced malignant glaucoma after repeat penetrating keratoplasty (PK). Methods Retrospective review of the patient’s medical records and review of literature on EBV corneal endotheliitis and/or anterior uveitis. Results A 78-year-old Thai female patient presented with a markedly edematous corneal graft, dense pigmented keratic precipitates, fibrinous anterior chamber reaction, uniformly flat anterior chamber, and ocular hypertension of 55 mmHg in the left eye on the first day after the third PK. An aqueous tap for polymerase chain reaction analysis was positive for EBV DNA but negative for other herpesviruses. The patient was diagnosed with EBV endotheliitis and anterior uveitis-induced malignant glaucoma; and successfully treated with oral valacyclovir and topical 2% ganciclovir eye drops. Conclusions EBV endotheliitis and anterior uveitis can induce malignant glaucoma following PK. A high index of suspicion is required when a patient has a history of unexplained multiple graft rejections.

Recurrent keratoconus: an analysis of breaks in Bowman’s layer in corneal grafts

ObjectiveTo study in a masked fashion whether an objective histological feature associated with keratoconus (KCN) occurs in donor corneas in eyes originally receiving a corneal graft for KCN.MethodsTwo ocular pathologists...

Assessing the Learning Curve for DMEK Using Post-Procedural Clinical Outcomes-Comparison of Four Different Surgeons during Two Different Periods.

Evaluating the learning curve of individual surgeons for Descemet Membrane Endothelial Keratoplasty (DMEK) and Triple-DMEK and assessing outcome with experience. The first 41 and the last 41 surgeries of each of the four surgeons were retrospectively included. Surgery duration and graft preparation time were recorded. Corrected distance visual acuity (CDVA, logMAR) and central corneal thickness (CCT, µm) were collected preoperatively after 6 and 12 months, as well as postoperative complications, e.g., re-bubbling or repeat penetrating keratoplasty. Surgical duration for Triple-DMEK and DMEK decreased significantly by 21 min and 14 min between the two periods (p < 0.001; p < 0.001). Graft preparation time decreased significantly from 13.3 ± 5.2 min (95%CI 12.8-14.3) in period 1 to 10.7 ± 4.8 min (95%CI 10.2-11.4) in period 2 (p = 0.002). The postoperative changes in CDVA and CCT over both periods were not significant (p = 0.900; p = 0.263). The re-bubbling rate decreased significantly from 51.2% in period 1 to 26.2% in period 2 (p < 0.001). The repeat penetrating keratoplasty (PKP) was 7.3% in period 1 and 3.7% in period 2 (p = 0.146). Re-DMEK was necessary in 6.1% in period 1 and 4.9% in period 2 (p = 0.535). Several parameters showed significant differences between the surgeons in both periods (surgical duration: period 1: p < 0.001, period 2 p < 0.001; graft preparation: period 1: p < 0.001, period 2 p < 0.001). Significant decrease in surgery duration, graft preparation time, and the re-bubbling rate can be attributed to gained individual experience.

En Bloc Keratolimbal Allograft and Central Penetrating Keratoplasty: A Novel Surgical Technique in Severe Limbal Stem Cell Deficiency.

The purpose of this study was to present a novel surgical technique combining 360-degree keratolimbal allograft (KLAL) and simultaneous central keratoplasty termed en bloc KLAL with the central penetrating keratoplasty (PKP) performed in those cases with total limbal stem cell deficiency (LSCD) and corneal scars. Nine eyes of 9 patients underwent en bloc KLAL and central PKP between 2014 and 2016. All patients had bilateral total LSCD with total corneal opacity due to different etiologies. The exclusion criteria were previous limbal stem cell transplantation and the presence of active and uncontrolled ocular surface inflammation. The same donor globe was used for harvesting 360-degree KLAL and central PKP. The 1-piece integrity of the KLAL and PKP graft was preserved during the described technique. All patients received modified immunosuppressive regimens compatible with the Cincinnati solid organ transplantation protocol. The average age of patients was 58.6 ± 18.6 years. The diagnosis was mustard gas keratopathy in 6, herpes simplex keratitis in 1, and severe acid chemical burn in 2 patients. Seven patients were male. An integrated ocular surface without epitheliopathy and a clear cornea was achieved in 8 patients (88.8%) with an average of 6.5 years in follow-up. The average best-corrected visual acuity was 1.89 ± 0.18 (20/1600) preoperatively which improved to 1.02 ± 0.64 (20/200) logMAR in the postoperative period. Endothelial immune rejection episodes were observed in 3 patients. KLAL rejection was not observed in any patient. One patient required repeat PKP due to corneal graft failure. En bloc 360-degree KLAL and central PKP could simultaneously be performed in patients with total LSCD and corneal opacification.

Infectious Crystalline Keratopathy after Penetrating Keratoplasty with Light and Electron Microscopic Examination.

To highlight the typical histological and ultrastructural features of severe infectious crystalline keratopathy (ICK) in a corneal graft, which required excimer laser-assisted repeat penetrating keratoplasty (PKP) and to present the challenging treatment conditions associated with ICK. An 85-year-old female patient underwent PKP for secondary graft failure after Descemet membrane endothelial keratoplasty (DMEK) for Fuchs' endothelial corneal dystrophy in the left eye. One year later, white branched opacities were observed in the superficial corneal stroma of the graft without surrounding inflammation in the left eye. The patient underwent excimer laser-assisted repeat PKP (8.0/8.1 mm) in the left eye after prolonged refractory topical anti-infectious treatment for 1 month. The corneal explant was further examined by light and transmission electron microscopy (TEM). The light microscopic examination of the corneal explant demonstrated aggregates of coccoid bacteria in the superficial and mid-stromal region that were positive for periodic acid-Schiff (PAS) and Gram stain. The bacterial aggregates extended into the interlamellar spaces, showed a spindle-shaped appearance, and were not surrounded by an inflammatory cellular reaction. TEM demonstrated lamellae separation within the anterior corneal stroma with spindle-shaped aggregates of bacteria, which were embedded in an extracellular amorphous matrix with incipient calcification, being consistent with a biofilm. No inflammatory cellular reaction was evident by TEM. At discharge from hospital, the corrected visual acuity was 20/80 in the left eye. ICK is often challenging due to the difficult diagnosis and treatment conditions. The refractory courses are mainly attributed to a biofilm formation, which inhibits effective topical anti-infectious treatment. In such cases, (repeat) PKP may be necessary to completely remove the pathology, prevent recurrences, and improve vision.

Impact of gender mismatch on corneal graft rejection and rejection-related graft failure in repeat penetrating keratoplasty.

To explore the impact of gender mismatch on corneal allograft rejection and rejection-related graft failure in patients with repeat penetrating keratoplasty (PK). A retrospective cohort was conducted at Ramathibodi Hospital, Bangkok, Thailand. Patients with repeat PK and follow-up period of at least 6 months were recruited. Demographic data, pre-operative ocular findings and donor information were collected. Patients were divided into 2 groups according to gender mismatch between donor and recipient (male to female vs others). Survival analysis was performed using the Kaplan-Meier method. The association between risk factors and the outcomes of graft rejection and rejection-related graft failure were analyzed using Cox proportional hazards regression. Of 68 patients with repeat PK, 26 patients (38.2%) were gender mismatched. There was no difference in 3-year rejection-free survival and graft survival between patients with gender mismatch and others (p = 0.698 and p = 0.402, respectively). Younger recipients (< 40 years) showed a significantly higher rejection rate compared to older recipients (hazard ratio; HR = 3.14, 95% confidence interval; CI 1.15 to 8.58), while patients with multiple PK (> 2 times) were found to be significantly associated with higher rejection-related graft failure compared to patients with 2 times or less PK (HR = 2.72, 95% CI 1.03 to 7.21). After multivariate analysis, only younger recipients demonstrated a statistical significance on graft rejection (adjusted HR = 2.86, 95% CI 1.04 to 7.84). Gender mismatch might not impact corneal graft rejection or rejection-related graft failure in patients with repeat PK. Younger age was found to be a strong factor associated with graft rejection. Gender matching might not be compulsory for repeat PK.

Management of Late Descemet's Membrane Detachment After Penetrating Keratoplasty in Keratoconus.

The purpose of this study was to describe the feasibility of Descemet membrane endothelial keratoplasty (DMEK) as a treatment modality for spontaneous detachment of DM (DMD) decades after penetrating keratoplasty (PK) for keratoconus. We describe the clinical characteristics and therapeutic surgical approach in 6 eyes of 5 patients with DMD. Clinical images, anterior segment optical coherence tomography scans, and histological findings are presented. Mean age of patients at time of diagnosis was 60 years (range 56-66 years). Mean interval between PK and occurrence of DM detachment was 36 years (range 29-45 years). In 4 of 6 eyes, air injections into the anterior chamber were initially attempted to reattach DM to the stroma but without long-lasting effect. Two eyes underwent repeat PK because of pronounced ectasia after long-standing DMD and stromal scars. DMEK was performed successfully in 4 eyes leading to an increase in visual acuity and a reduction in central corneal thickness. Electron microscopy showed abnormal vacuolar inclusions and collagenous material in the posterior nonbanded layer and a separation of the anterior banded layer from the posterior nonbanded layer. This case series provides evidence that DMEK is a viable option in eyes with spontaneous DM detachment after PK. Visual outcome is limited by the persisting high astigmatism in the ectatic cornea. Illustrated by a small series of patients, the results of DMEK in this condition are presented and new findings about the pathophysiology are given.

Incidence and risk factors for post-penetrating keratoplasty glaucoma.

Purpose:To carry out a prospective study to analyze the incidence and various preoperative, intraoperative, and postoperative risk factors for the development of PPKG.Methods:A total of 207 patients were analyzed prospectively, who were operated for penetrating keratoplasty (PK) in a tertiary eye care hospital between the time period of August 1, 2017 and February 28, 2018 and were followed up till the sixth month. Each patient was analyzed at every visit to determine the factors responsible for post-keratoplasty glaucoma.Results:Out of 207 eyes, post-PK glaucoma developed in 84 cases, which yielded an incidence of 41%. Incidence of PPKG (Post PK glaucoma) in various conditions was as follows: in repeat PK 62%, in perforated corneal ulcer 33%, in nonperforated corneal ulcer 29%, in corneal scar including adherent leukoma 37.2%, and in pseudophakic bullous keratopathy and aphakic bullous keratopathy, 14% and 80%, respectively. In age- and sex-adjusted multivariate analysis, the significant risk factors were age (P-value- 0.006), presence of PAS (P-value 0.001), and fellow eye glaucoma (P-value 0.04). Aphakia and combined surgery were not found to be significantConclusion:Our study recommends a meticulous examination of the fellow eye to assess the presence of glaucoma as it can increase the suspicion of glaucoma in the eye to be operated. The presence of PAS and age are important risk factors for developing PPKG. The risk of developing PPKG increases exponentially as the number of risk factors increases, but the presence of more than three risk factors does not add to the development of PPKG.

Outcomes following tacrolimus systemic immunosuppression for penetrating keratoplasty in infants and young children.

To report outcomes of tacrolimus immunosuppression after penetrating keratoplasty (PK) in very young children. Retrospective, consecutive, cohort study of children undergoing PK at a tertiary children's hospital between 2005 and 2016. Oral tacrolimus immunosuppression was given for 2 years, followed by topical tacrolimus. Fourteen children (20 eyes) had 24 PKs; nineteen eyes had primary PKs, five eyes had repeat PKs. Mean age at primary graft was 95 days (3.1 months) for anterior segment dysgenesis (ASD), 430 days (14.3 months) for non-ASD children. Eleven children (15 eyes) had ASD. Three children (five eyes) had non-ASD: two children (three eyes) had glaucoma-related corneal opacity and one child (two eyes) had congenital hereditary endothelial dystrophy (CHED). One-year rejection-free survival rates following primary PK was 80% for ASD (n = 15) and 100% for non-ASD (n = 4). At final review, 5/15 of primary grafts for ASD were clear. 10/15 failed after a mean of 19 months, specifically attributable to infection (n = 2), rejection (n = 2) and glaucoma (n = 2). 4/4 primary non-ASD grafts are clear at final review (mean follow-up = 77 months). All repeat grafts (n = 5), failed after a mean of 38.25 months. Considering all grafts, 15/24 (62.5%) failed: 5/15 due to infection, 2/15 due to rejection, 8/15 due to glaucoma, phthisis, perforation or vascularised with no rejection. At last review (mean = 58.1 months, range 28-84), overall cohort survival is 37.5%. Final visual acuities range between 0.86 and 2.4 LogMAR. We compare our results to published literature: 1-year graft survival was higher than previously reported, with lower failure due to rejection. Overall infection rates did not increase, however, proportionally, severe infections were higher. Overall graft survival is at least comparable to reported literature.

TEMPORARY KERATOPROSTHESIS WITH PENETRATING KERATOPLASTY IN CONJUNCTION WITH PARS PLANA VITRECTOMY FOR REPAIR OF RETINAL DETACHMENTS IN PATIENTS WITH ANTERIOR AND POSTERIOR SEGMENT PATHOLOGY.

To review the visual and anatomical outcomes of combined anterior and posterior segment surgery for retinal detachment repair. Eight patients with combined retinal and corneal disease underwent combined temporary keratoprosthesis with penetrating keratoplasty combined with pars plana vitrectomy for retinal detachment repair with silicone oil tamponade. Visual and anatomical outcomes were reviewed retrospectively. Follow-up ranged from 12 months to 37 months. Preoperative visual acuity ranged from light perception to hand motion. All but one case had proliferative vitreoretinopathy present at the time of surgery. Postoperative visual acuity ranged from hand motion to light perception. At the most recent follow-up visit, all of the patients had attached retinas, no patients had phthisis bulbi, and all but one patient had a clear cornea. However, 3 of these cases (38%) required repeat retinal detachment repair and one of them also required repeat penetrating keratoplasty, which was performed at the time of retinal repair. Combined full-thickness penetrating keratoplasty and retinal detachment repair has good anatomical outcomes and is an efficient way to treat complex anterior and posterior segment abnormality. Although postoperative visual function is limited; almost all patients were agreeable to repeat surgery if they were presented with the choice again.

Contralateral autologous corneal transplantation in an human immunodeficiency virus-positive patient with multiple failed grafts: A challenging experience

A 61-year-old human immunodeficiency virus (HIV)-positive female patient, planned for a repeat penetrating keratoplasty in the left eye after two failed grafts, also had an absolute right eye and a clear cornea with healthy endothelium (CD4-2445 cells/mm2) with no perception of light. Due to an unexpected damage to the only optical grade tissue that occurred during surgery, consent was taken from the patient to perform an autokeratoplasty from the contralateral blind eye and was successfully performed on the left eye with visual potential. The blind eye received a therapeutic grade donor tissue.

Кератопластика с инстрастромальной имплантацией гидрогелевого материала как выбор при многократных ре-СКП (клиническое наблюдение)

Кератопластика с инстрастромальной имплантацией гидрогелевого материала как выбор при многократных ре-СКП (клиническое наблюдение)

Clinical Outcomes of Micropulse Transscleral Cyclophotocoagulation in Patients with a History of Keratoplasty

Purpose To examine the surgical outcomes and graft conditions in patients receiving micropulse transscleral cyclophotocoagulation (MP-TSCPC) to treat post-keratoplasty ocular hypertension. Methods This retrospective observational study included 30 eyes of 28 consecutive glaucoma patients with a history of penetrating keratoplasty (PKP) or Descemet's stripping automated endothelial keratoplasty (DSAEK) who underwent MP-TSCPC at the University of California, San Francisco from 09/2015 to 08/2018. Using the Wilcoxon signed-rank test, we compared preoperative and postoperative intraocular pressure (IOP), number of glaucoma medications, visual acuity, and central corneal thickness at 1, 3, 6, and 12 months. Postoperative complications, additional surgeries, and graft failures were also recorded at these follow-up times. Linear regression model was used to study whether PKP vs. DSAEK affects the effectiveness of MP-TSCPC. Results Thirty eyes from 28 patients were followed for 12 months. IOP was significantly decreased from preop at all follow-up points (P < 0.001). There was no significant change in the number of glaucoma drops, visual acuity, or CCT. At 12 months, 21 of the 30 eyes met the definition of success, and only one underwent repeat PKP due to graft rejection. The type of corneal transplant was not a significant factor for IOP reduction at the last follow-up. Conclusions MP-TSCPC achieved desirable IOP control and success rates for postkeratoplasty patients while resulting in minimal complications and graft failure. It appears to be a safe and effective procedure in patients who received corneal transplant with one-year follow-up.

8.5/8.6-mm Excimer Laser-Assisted Penetrating Keratoplasties in a Tertiary Corneal Subspecialty Referral Center: Indications and Outcomes in 107 Eyes.

To report the indications and outcomes of 8.5/8.6-mm excimer laser-assisted penetrating keratoplasties (PKPs) at a tertiary corneal subspecialty referral center. This retrospective, descriptive, observational study included 107 PKPs performed in 96 patients (mean age, 53 ± 12 years). The patients' indications for surgery, best-corrected visual acuity, surface regularity index, surface asymmetry index, topographic astigmatism, central endothelial cell density, central corneal thickness, and graft status were recorded preoperatively, 6 weeks postoperatively, and before (12 ± 2 months) and after (19 ± 4 months) the suture removal. The surgeries included 48 primary PKPs and 59 repeat PKPs. The main indications were corneal ectatic disorders (50%), severe corneal keratitis (21%), and corneal scars (16%) in the primary PKP group and highly irregular astigmatism after PKP (51%) and previous graft decompensation (37%) in the repeat PKP group. From preoperative measurements to the last follow-up visit without sutures, we found significant improvements (P < 0.001 for all) in visual acuity (0.7 ± 0.3 LogMAR to 0.3 ± 0.2 LogMAR), surface regularity index (1.5-1.0), and surface asymmetry index (2.59-1.1). At the last follow-up, the mean outcome measurements did not significantly differ between the primary and repeat PKP groups. Overall, 89 grafts (83%) remained clear at the last follow-up. In cases of ectatic disorders and highly irregular astigmatism after keratoplasty, 8.5/8.6-mm excimer laser-assisted PKP seems to be an excellent treatment option, achieving a significant improvement in visual acuity.

Inverted In Vitro Confocal Microscopy in Mycotic Keratitis with Corneal Endothelial Epithelial Decompensation

The sensitivity of confocal microscopy ranges between 80 and 90% and thus lies above the sensitivity of pathogen identification by microbiological culture. Typically, in vivo confocal microscopy enables us to diagnose mycotic keratitis non-invasively and atraumatically on the day of admission. Herein we present a patient with an ulcer on a corneal graft, pronounced corneal endothelial epithelial decompensation and a retrocorneal fungal adhesion after repeat-keratoplasty 5 years ago - due to chronic graft rejection after keratoplasty for Fuchs endothelial corneal dystrophy. Clinically there was a suspicion of fungal keratitis. Conventional en face confocal microscopy, however, did not detect hyphae. Due to the pronounced corneal endothelial epithelial decompensation, we were able to detect the fungal hyphae only after repeat penetrating keratoplasty by means of inverted in vitro confocal microscopy on the day of surgery. Histology confirmed the diagnosis of keratomycosis.

A Clinical Study of Factors Influencing Graft Success after Repeat Penetrating Keratoplasty and their Management

A Clinical Study of Factors Influencing Graft Success after Repeat Penetrating Keratoplasty and their Management

Descemet membrane endothelial keratoplasty after penetrating keratoplasty

# Purpose To describe visual and clinical outcomes of descemet membrane endothelial keratoplasty (DMEK) for late endothelial failure after penetrating keratoplasty (PK). # Methods Retrospective, observational study of patients who consecutively received DMEK to treat PK graft failure. Intraoperative complications were recorded. Our previously described DMEK surgical technique was used except that host descemet membrane was not stripped in any of the eyes. Corrected distance visual acuity (CDVA), and endothelial cell density (ECD) were evaluated before surgery and at regular intervals up to 24 months after the surgery. # Results Twenty-six eyes of 26 patients were included. Mean host age was 58.50 ± 12.50 years old. Mean donor age was 65.30 ± 10.49. Mean follow up after DMEK was 23.08 ± 10.27 (range 6 months–48 months). Seventeen (65.38%) eyes reached at least the 24-month follow up time point. At last follow up, 24 eyes (92.31%) presented with clear corneas. Twenty-four months postoperatively, mean Snellen CDVA in decimal fraction was 0.75 ± 0.03 (range 0.6–0.80) and mean central endothelial cell density was 1480.41 ± 320.56 cells/mm2 (range, 591–1950 cells/mm2). Mean cell loss at 6 months was 27.67 ± 16.03%. Three (11.53%) eyes had significant graft detachment that required re-bubbling. No episodes of immunological graft rejection were documented. # Conclusions Our experience shows that DMEK is a useful technique to treat endothelial graft failure following PK. Compared to repeat PK, DMEK-specific surgical complications and postsurgical management should be expected.