Endothelial keratoplasty to restore clarity to a failed penetrating graft

To describe an adaptation of endothelial keratoplasty to restore corneal clarity to a prior penetrating keratoplasty (PK) with endothelial decompensation.

A surgeon's initial 7 consecutive cases using endothelial keratoplasty for treatment of failed prior PK were retrospectively analyzed. The treated eyes had all experienced endothelial decompensation after previously having clear corneal transplants. Instead of repeating the PK, a partial-thickness donor button, composed of posterior stroma with Descemet membrane and endothelium, was grafted to the posterior surface of the failed full-thickness donor graft. In 6 of the 7 cases, the only sutures were those used to close a 5-mm scleral tunnel incision. The donor button was initially held in place with an air bubble and later attached on its own.

In all cases, the new donor button adhered to and cleared the edema from the previous penetrating graft. Within 3 months of endothelial keratoplasty, best-corrected visual acuity had improved in 6 of the 7 cases compared with the preoperative vision.

Standard PK usually takes months to years to heal sufficiently to remove sutures and provide patients with a stable refraction and a wound strong enough to withstand minor trauma. Using endothelial keratoplasty to rehabilitate a failed graft may provide faster visual recovery, a tectonically stronger eye, and a reduced period of disability compared with repeating the PK. Endothelial keratoplasty may be a particularly useful alternative for treating penetrating grafts that achieved acceptable refractive and ocular surface results but failed because of endothelial dysfunction.