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Repeat keratoplasty for failed Descemet’s stripping automated endothelial keratoplasty: factors affecting decision-making

Poster Details

First Author: J.Titiyal INDIA

Co Author(s):    M. Kaur   M. Gagrani   F. Shaikh              

Abstract Details


To evaluate the clinical factors influencing decision making regarding repeat descemet stripping automated endothelial keratoplasty (DSAEK) or penetrating keratoplasty (PKP) in cases of failed DSAEK


Dr Rajendra Prasad Centre for Ophthalmic sciences, AIIMS, New Delhi, India


Retrospective observational study of cases with failed DSAEK admitted to our centre for a repeat keratoplasty over five years (Jan. 2013- Dec. 2017) was undertaken. Cases with incomplete medical records were excluded. Perioperative details and type of repeat keratoplasty were recorded


A total of 94 eyes with failed DSAEK were evaluated. Repeat DSAEK was performed in 66% and PKP in 34% cases. Significantly increased odds for PKP were associated with stromal scarring (OR= 2.9), trainee surgeons (OR=4.05), intraoperative complications (OR= 4.58), SFIOL/ ACIOL in situ (OR=33.8), secondary glaucoma (OR=3.02), PAS (OR=8.6), preoperative corneal thickness (OR=1.01), time to primary surgery (OR-=1.03), post-DSAEK host thickness (OR=1.01) and time interval from graft failure to re-graft (OR=1.18). All eyes with CHED, bee-sting induced decompensation, Axenfeld Rieger syndrome and multiple failed grafts underwent PKP. All cases requiring surgery for glaucoma underwent PKP (p<0.001).


Decision making for repeat keratoplasty after failed DSAEK is influenced not only by the ocular state at the time of re-graft, but by the entire preoperative, intraoperative and postoperative course of the primary surgery

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