Assessment Of Outcomes Of Endothelial Keratoplasty Following Failed Penetrating Keratoplasty

To assess the visual and clinical outcomes of endothelial keratoplasty (EK) for failed penetrating keratoplasty (PKP).

King Khaled Eye Specilaist ,Riyadh , Saudi Arabia 

A retrospective review was conducted of patients who underwent endothelial keratoplasty for failed PKP at King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia, between January 2011 and December 2024. Patients who had primary endothelial keratoplasty, repeat PKP, or lamellar keratoplasty were excluded. Data were collected on patient demographics, indications for PKP, history of glaucoma, type of EK, endothelial graft diameter, graft insertion method, development of graft rejection or failure, and graft survival at final follow-up. Main outcome measures included graft survival, best-corrected visual acuity (BCVA), and complications. Graft survival probability was calculated using Kaplan–Meier analysis

Mean age was55.5 ± 20.8 years.Surgeon-cut DSAEK was performed in37eyes(71.2%).Mean BCVA improved from1.6 ± 1.6 logMAR preoperatively to 1.0 ± 1.0 logMAR at 1year(P < 0.001)and was maintained at final follow-up(1.1 ± 1.1logMAR,P = 0.002).Donor graft size was associated with early graft failure at6 months(P = 0.048)but donor–recipient size mismatch did not significantly affect outcomes.At 1 year,grafts were clear in 37 eyes (71.2%),rejected in 3(5.8%),and failed in12(23.1%).Kaplan–Meier analysis estimated a median graft survival of 3.4 years(95% CI 0.69–6.07)Bullous keratopathy was associated with lower risk of graft failure(OR = 0.02, 95% CI 0.001–0.798, P = 0.038).while surgeon-cut DSAEK was associated with higher rejection rates(P = 0.002)

EK after failed PKP improves visual outcomes with acceptable short-term graft clarity. Donor graft size, bullous keratopathy, and EK type influence early graft failure and rejection. EK represents a viable alternative to repeat PK for endothelial failure.