Outcomes Of Lamellar Surgery Following Failed Penetrating Keratoplasty
Published 2023 - 41st Congress of the ESCRS
Reference: PP24.12 | Type: Free paper | DOI: 10.82333/np84-sn59
Authors: Ameeta Kumar* 1 , Ken Kawamoto 2 , Tina Khanam 1
1Moorfields Eye Hospital,London,United Kingdom, 2Central Middlesex Hospital,London,United Kingdom
Purpose
Penetrating keratoplasty (PK) is widely performed to treat corneal pathologies such as ectasias, corneal dystrophies, pseudophakic bullous keratopathy, microbial keratitis and chemical injuries. Studies have shown that long-term failure rates of PK grafts can be as high as 35%, with an even worse prognosis for repeat PKs. Lamellar surgery such as Descemet Membrane Endothelial Keratoplasty (DMEK) or a Descemet stripping and automated endothelial keratoplasty (DSAEK) can be an alternative treatment for previously failed PK. This study aims to evaluate the clinical outcomes of lamellar surgery following a failed PK in a tertiary centre in the UK.
Setting
The study was carried out at a tertiary centre, Moorfields Eye Hospital, UK
Methods
We performed a retrospective review of patients undergoing lamellar surgery between 2010 and 2021, following a failed previous PK. Best-corrected visual acuity (BCVA) was recorded pre-operatively and post-operative soon after surgery, at 3-6 months, at 12 months and at 24 months were recorded. Past ophthalmic history and graft outcomes were obtained using physical and electronic medical records.
Results
30 eyes underwent either a DMEK or a DSAEK following their first PK. The mean age of patients was 56 years and 46.7% of eyes had pre-existing glaucoma. The most common indication for the initial PK was keratoconus, followed by corneal dystrophy and corneal decompensation following phacoemulsification. The mean pre-operative BCVA was 1.4. Postoperative BCVA was 0.8 at 3-6 months and 0.6 at 12 months. The mean improvement in visual outcome was 0.6 at 3-6 months and 0.7 at 12 months. 26.7% of cases underwent rebubbling at a mean of 8.5 days following the surgery. The graft failure rate is 30.0% with a mean onset time of 511.7 days post-surgery. The graft rejection rate was 13.3% with a mean onset time of 322.5 days post-surgery.
Conclusions
Lamellar surgery is a promising option for patients with poor visual outcomes following failed PK. Our lamellar graft failure rates are lower than those reported for repeat PKs.