Outcomes Of Endothelial Keratoplasty For Corneal Transplant Failure
Published 2025 - 43rd Congress of the ESCRS
Reference: FP07.09 | Type: Free paper | DOI: 10.82333/dw6j-mh56
Authors: Nuno Álvaro Ferreira Silva* 1 , Joao Paulo Macedo 1 , Pedro Neves Cardoso 1
1Oftalmologia ,Centro Hospitalar e Universitario de Sao Joao,Porto,Portugal
Purpose
To assess the outcomes of endothelial keratoplasty (EK) in eyes with prior failed corneal transplantation.
Setting
A retrospective analysis of Descemet membrane endothelial keratoplasty (DMEK) and Descemet stripping endothelial keratoplasty (DSEK) procedures performed in eyes with prior keratoplasty by 2 surgeons (AJA and SXD) at the Stein Eye Institute between 2014 and 2024.
Methods
Preoperative, intraoperative and postoperative data was collected for 295 EK (117 DMEK and 178 DSEK) procedures performed in 221 eyes of 208 patients, although only eyes with > 6 months of postoperative follow-up were included in the analysis of the primary outcome measures of DMEK and DSEK graft survival, corrected distance visual acuity (CDVA) and graft rejection. Secondary outcome measures included other postoperative complications, such as graft detachment, pupillary block, donor-related infection and cystoid macular edema (CME).
Results
Mean preop logMAR CDVA was 1.26 and mean best postop CDVA was 0.49 logMAR. 137 (46%) grafts failed during a mean follow-up of 33.2 months; 3 (1%) due to primary graft failure and 134 (45%) due to secondary graft failure. The graft survival rate was 50% at 3 years and 30% at 5 years. While the number of prior grafts and a history of medical or surgical treatment for glaucoma were associated with a lower mean graft survival, there was not a correlation between the type of EK performed (DMEK versus DSEK) and graft survival. Graft detachment developed after 75 procedures (29%), requiring rebubbling following half (38) of these procedures. Endothelial rejection developed following 55 (21%) and CME developed following 30 (11%) procedures.
Conclusions
While EK for corneal transplant failure significantly improves CDVA, the incidence of graft detachment, endothelial rejection and CME are significantly higher than after EK for other indications. Additionally, as fewer than half of the EK grafts survive more than three years after surgery, alternative approaches are needed for the management of endothelial failure following corneal transplantation.