Corneal Endothelial Keratoprosthesis (Endoart) Implantation For Endothelial Failure After Penetrating Keratoplasty – Preliminary Results

To report visual, anatomical, and safety outcomes of EndoArt implantation in eyes with endothelial failure after penetrating keratoplasty (PK) and multiple anterior segment comorbidities. This represents the first reported cohort of EndoArt implantation specifically in post‑PK eyes. Further results from an expanded cohort will be presented at the conference.

Tertiary referral centre, Department of Ophthalmology, LMU University Hospital Munich, Germany and Department of Ophthalmology, Red-Cross Hospital, Munich, Germany.

This retrospective case series included 9 eyes of 8 male and 1 female patient (mean age 55.0 ± 22.4 years) with chronic endothelial decompensation after PK and a minimum follow‑up of 6 months (mean 8.5 ± 3.8 months). Underlying indications for PK included aniridia, perforating trauma, keratoconus, prior keratitis, scarring conjunctivitis, and pseudoexfoliation glaucoma. All eyes had significant comorbidities such as glaucoma, glaucoma drainage devices, artificial iris implants or scleral‑fixated IOLs. Main outcome measures were best‑corrected distance visual acuity (BCVA, logMAR), central corneal thickness (CCT), adverse events, corneal clarity, failure (persistent non‑attachment at 6 months), and need for re‑intervention procedures.

All eyes had chronic endothelial decompensation at baseline, with a mean preoperative CDVA of 1.83 ± 0.63 logMAR. Mean CDVA improved to 1.38 ± 0.62 logMAR at 3 months and 1.27 ± 0.52 logMAR at 6 months. Re‑bubbling or revision surgery was required in 5/9 eyes (55.6 %; 1 eye with 1 procedure, 3 eyes with 2 procedures, 1 eye with 4 procedures). CCT improved from 890.11 ± 209.75 µm preop to 634.11 ± 190.72 µm at 6 months. Mean number of sutures was 3.44 ± 1.42. Corneal clarity with visible fundus details was documented in 8/9 eyes (88.9 %). One eye (11.1 %) met failure criteria due to persistent non‑attachment after 6 months. Adverse events included one case of persistent cystoid macular oedema and two cases of progressive corneal thinning.

EndoArt implantation provided meaningful visual improvement and restoration of corneal clarity in most highly complex post‑PK eyes with endothelial failure, although overall visual acuity remained limited by the underlying pathology, particularly advanced glaucoma. Despite a substantial re‑intervention rate, only one eye showed persistent non‑attachment at 6 months. With repeat PK being avoided 88.9% of cases, our data suggest that EndoArt may represent a feasible, tissue‑sparing option in eyes with limited graft and endothelial keratoplasty alternatives. Since these are extremely complex eyes in which repeat PK would be the only remaining alternative, we believe that these results clearly support offering this option whenever feasible.