Repeat Dsaek Outcomes : A Comparative Study Of Primary And Repeat Endothelial Keratoplasty

To compare the clinical outcomes of primary Descemet Stripping Automated Endothelial Keratoplasty (DSAEK) with repeat DSAEK performed in the same eyes following graft failure.

This is a retrospective study which included all eyes that underwent repeat DSAEK between January 2015 and December 2024 at a tertiary eye care center in Southern part of India. Eyes that underwent Descemet Membrane Endothelial Keratoplasty (DMEK), penetrating keratoplasty (PKP), or more than two consecutive DSAEK procedures were excluded.

The medical files of all eligible patients were reviewed. Pre operative data like age, sex, ocular diagnosis, no of previous surgeries, lens status, best corrected visual acuity (BCVA) were noted. Donor characteritics like donor age, endothelial cell density (ECD), pachymetry and intraoperative data like lenticule size, DM stripping status and any additional interventions were analyzed. Post operative data like follow-up duration, BCVA, complications and outcomes were considered for evaluation

Out of 452 DSAEK procedures performed, 39 eyes underwent repeat DSAEK. The mean age at first surgery was 69.9 ± 11.9 years. The most common indication for primary DSAEK was failed graft (38.9%), followed by pseudophakic bullous keratopathy (30.6%).For primary DSAEK, common causes of graft failure were graft rejection (30%), graft detachment (27.8%), and glaucoma (27.8%). In repeat DSAEK, the most common cause of graft failure was glaucoma (44.5%), followed by graft rejection (11%). Rebubbling rate was significantly lower (p=0.01). Primary graft failure was significantly reduced in repeat DSAEK compared to first DSAEK (16.7% vs 47.2%, p=0.005). Mean logMAR BCVA improved from 1.76 to 1.28 following repeat surgery (p=0.001).

Repeat DSAEK is an effective surgical option for failed primary DSAEK, demonstrating significant visual improvement and acceptable graft survival. Although glaucoma remains a major risk factor for failure, repeat endothelial keratoplasty offers favorable anatomical and functional outcomes, making it a viable alternative to full-thickness keratoplasty in selected cases.