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Descemet’s stripping automated endothelial keratoplasty (DSAEK) after failed penetrating keratoplasty (PKP) – a multicenter analysis of survival, risk and visual outcome

Session Details

Session Title: Cornea surgical I

Session Date/Time: Tuesday 08/10/2013 | 08:00-10:30

Paper Time: 08:54

Venue: Forum (Ground Floor)

First Author: : D.Mitry UK

Co Author(s): :    M. Bhogal   B. Allan           

Abstract Details


To report the long term survival, the risk factors for graft failure and the final visual outcome of DSAEK after a failed PKP


A multi-centre retrospective case series comprising 246 consecutive grafts from 6 tertiary referral centres worldwide


A Kaplan–Meier analysis was used to determine the cumulative probability of graft survival and a Cox proportional multivariate regression model was fitted to examine for prognostic factors associated with DSAEK failure after PKP.


The mean(SD) recipient age was 63.2(16.6) years and the median follow-up period was 17 months (range: 8 days-72 months). In total, 53% were male, 74.8% had a posterior chamber intra-ocular lens at the time of surgery and 19% had more than one failed PKP prior to DSAEK. At final follow-up, 19.1%(47/246) of grafts had failed. The cumulative probability of DSAEK survival after a failed PKP graft in the entire cohort was 0.89, 0.74 and 0.47 at 1 year, 3 years and 5 years respectively. Significant independent risk factors for graft failure on multivariate analysis were age group, cause of PKP failure, centre and previous glaucoma surgery. At final follow-up, 64.6% of grafts achieved ? 6/18 (20/60) corrected distance visual acuity.


DSAEK after failed PKP carries a good visual outcome and a comparable if not better survival rate to repeat PKP. Young age, rejection, surgical centre and previous glaucoma shunt surgery are associated with a higher risk of subsequent graft failure.

Financial Interest:


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