Official ESCRS | European Society of Cataract & Refractive Surgeons


Analysis of repeat Descemet's stripping automated endothelial keratoplasty (reDSAEK) from a tertiary centre of ophthalmology in Portugal

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Session Details

Session Title: Cornea Surgical: Lamellar Corneal Grafts

Session Date/Time: Tuesday 17/09/2019 | 08:30-10:30

Paper Time: 10:00

Venue: Free Paper Forum: Podium 3

First Author: : N.Moura-Coelho PORTUGAL

Co Author(s): :    D. Hipólito Fernandes   S. Crisóstomo   N. Alves   P. Candelária   V. Maduro   J. Feijão              

Abstract Details


To describe the clinical data and results of repeat Descemet Stripping Automated Endothelial Keratoplasty (reDSAEK) in a tertiary center of Ophthalmology in Portugal.


Tertiary Center of Ophthalmology in Lisbon, Portugal, which represents a referral center for corneal transplantation.


Retrospective study. Of 141 consecutive Descemet Stripping Automated Endothelial Keratoplasty (DSAEK) surgeries performed between 2016 and 2017, 35 (24.82%) were secondary DSAEK (reDSAEK) for failed primary DSAEK graft (pDSAEK). We analyzed: cause of failed pDSAEK; time between diagnosis of pDSAEK failure and reDSAEK; best-corrected visual acuity (BCVA,decimals) pre-reDSAEK; ocular comorbidities (pathologic anterior segment, history of glaucoma, uveitis, vitrectomy or retinopathy); donor reDSAEK graft endothelial cell count (ECC) and thickness (GT, determined by ultrasound pachymetry); intra and post-operative complications; need of rebubbling; BCVA at at 3, 6,12 months, and at last follow-up post-reDSAEK; rejection episodes; and reDSAEK failure.


Causes of pDSAEK failure were primary graft failure(PGF,33.30%), and secondary graft failure (SGF) from endothelial cell loss(45.50%) or rejection(21.20%). Mean pDSAEK survival (SGF eyes) was 15.4(8.8)months. Median time-to-reDSAEK was 5.0(5.0)months. Eighteen eyes(51.40%) had ≥1 ocular comorbidity. Mean donor GT and ECC were 182.7(27.4)µm and 2942.6(342.7)cel/mm2, respectively. No major intra- or early post-operative complications were registered; no cases underwent rebubbling. Seven eyes(20.0%) had PGF, 8 eyes(22.9%) developed SGF [median survival=11.0(9.0)months]. Median follow-up time post-reDSAEK was 18.0(18.0)months. Median BCVA statistically significantly improved at all timepoints (p≤0.002) post-reDSAEK [median pre-reDSAEK BCVA=0.014(0.009)]. In eyes with functioning reDSAEK, mean final BCVA was 0.471(0.261).


In our study, reDSAEK resulted in early, clinically significant improvement in BCVA after failed primary DSAEK. Eyes submitted to reDSAEK may be at an earlier and higher risk for graft failure than virgin DSAEK eyes; this might be in part due to the high percentage of ocular comorbidities in our study. In conclusion, reDSAEK is an effective technique to improve vision in cases failed DSAEK grafts.

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