Endothelial Keratoplasty In Cases Of Penetrating Keratoplasty Failure

To evaluate outcomes of endotelial keratoplasty: Descemet membrane endotelial keratoplasty (DMEK) and Descemet stripping endotelial keratoplasty (DSAEK) for failed penetrating keratoplasty (PK).

Fundación oftalmológica de la Comunidad Valenciana

Retrospective study of patients with PK failure who underwent DMEK or DSAEK. Host descemetorhexis was performed in all cases, the diameter of the endothelial graft was 0.5mm undersized in relation to the PK diameter, and the anterior chamber was pressurized with 20% SF6. Pre- and post-operative examinations included: best corrected visual acuity (BCVA), intraocular pressure (IOP), slit lamp examination, fundoscopy, Casia 2 pachymetry, and especular microscopy to asses the endothelium.

Seven eyes with PK failure were included. 4 DMEK and 3 DSAEK were. Among the postoperative complications we could highlight: rebubbling (2), synechiolysis (1), cystoid macular oedema (1) and primary graft failure (1). The median BCVA significantly improved from 0.02 [NPL-0.15] to 0.2 [0.01-0.6] (p=0.018). In the DMEK group the median corneal pachymetry decreased from 749 µm [590-958] to 599 µm [459-835] p=0.196, in the DSAEK group from 833 µm [656-846] to 680 µm [667-754] p=0.294. One case with a history of 3 previous PKs and multiple rejection episodes did not improve after 2 DMEKs. One patient did not improve VA due to an optic atrophy noticed after the DSAEK.

In our experience, endothelial keratoplasty is a viable and safer alternative for patients with endothelial PK failure that led to improved vision and graft clarity.