Clinical Outcomes Of Pre-Descemet Endothelial Keratoplasty In Challenging Eyes

To evaluate clinical outcomes after pre-Descemet endothelial keratoplasty (PDEK) in challenging eyes with significant ocular comorbidity, focusing on anatomical recovery and the need for secondary interventions.

University of Health Sciences, Ankara Bilkent City Hospital

A retrospective chart review was conducted on challenging eyes with various ocular risk factors (e.g., previous vitrectomy, glaucoma) that underwent PDEK between 2021 and 2025.  Demographics, ocular history, lens status, and postoperative interventions were recorded. At each visit, AS-OCT B-scans (Topcon DRI OCT Triton) were obtained to measure central corneal thickness (CCT) and evaluate graft attachment. Preoperative and final postoperative CCT values were statistically compared.

Thirty-five eyes were included, with a mean follow-up of 2.69 ± 7.53 months. The mean age was 62.2 ± 15.9 years, and 22 patients (63%) were female. A history of pars plana vitrectomy was present in 25 eyes (71%), with a mean interval of 844.6 ± 2002.6 days between PPV and PDEK. Five eyes (14%) had a history of glaucoma surgery, and 12 eyes (34%) had glaucoma. Central corneal thickness decreased significantly from 788.2 ± 150.9 μm preoperatively to 606.7 ± 129.2 μm at the final visit (p < 0.001). Postoperative rebubbling was required in 9 eyes (26%) at a mean of 1.8 ± 3.3 days. Re-PDEK was performed in 14 eyes (40%) at a mean of 92.16 ± 244.6 days, and 2 eyes (6%) required penetrating keratoplasty (PK).

In challenging eyes where penetrating keratoplasty might otherwise be considered, PDEK provided marked anatomical improvement, and the low conversion rate to PK supports its surgical success. However, the frequent need for rebubbling and repeat PDEK highlights the importance of close postoperative follow-up.