Descemet Membrane Endothelial Keratoplasty After Failed Penetrating Keratoplasty

To demonstrate the feasibility of Descemet membrane endothelial keratoplasty (DMEK) performed after previous penetrating keratoplasty (PK) failure and to describe primary outcomes.

Twenty-eight eyes of 28 patients who underwent DMEK after primary PK failure between January 2013 and November 2017 were included in this single-center retrospective study. Best spectacle-corrected visual acuity, endothelial cell density, and the recipient's central corneal thickness were recorded preoperatively and at 1, 3, and 6 months after surgery.

The main indications for primary PK were keratoconus (32%), Fuchs dystrophy (18%), and pseudophakic bullous keratopathy (14%). After a 6-month follow-up, best spectacle-corrected visual acuity was significantly improved in 26 patients (93%) with a mean gain of +0.59 ± 0.47 LogMAR (P < 0.0004). Mean pachymetry reduction was 110 ± 108 μm (P < 0.00003) at 6 months. Mean endothelial cell density was 2016 ± 288 cells/mm (P < 0.006), (24% decrease compared with preoperative values). Graft detachment (>1/3) was observed in 14 cases (50%) and rebubbling was needed (100% effective) during the first 2 weeks after surgery. Elevated intraocular pressure was reported in 5 cases. No early graft rejections were reported.

In case of previous PK failure, DMEK is an alternative treatment to re-PK. A longer follow-up to ensure the long-term viability of the graft is needed.