Descemet membrane endothelial keratoplasty after penetrating keratoplasty

Purpose

To describe visual and clinical outcomes of descemet membrane endothelial keratoplasty (DMEK) for late endothelial failure after penetrating keratoplasty (PK).

Methods

Retrospective, observational study of patients who consecutively received DMEK to treat PK graft failure. Intraoperative complications were recorded. Our previously described DMEK surgical technique was used except that host descemet membrane was not stripped in any of the eyes. Corrected distance visual acuity (CDVA), and endothelial cell density (ECD) were evaluated before surgery and at regular intervals up to 24 months after the surgery.

Results

Twenty-six eyes of 26 patients were included. Mean host age was 58.50 ± 12.50 years old. Mean donor age was 65.30 ± 10.49. Mean follow up after DMEK was 23.08 ± 10.27 (range 6 months–48 months). Seventeen (65.38%) eyes reached at least the 24-month follow up time point. At last follow up, 24 eyes (92.31%) presented with clear corneas. Twenty-four months postoperatively, mean Snellen CDVA in decimal fraction was 0.75 ± 0.03 (range 0.6–0.80) and mean central endothelial cell density was 1480.41 ± 320.56 cells/mm² (range, 591–1950 cells/mm²). Mean cell loss at 6 months was 27.67 ± 16.03%. Three (11.53%) eyes had significant graft detachment that required re-bubbling. No episodes of immunological graft rejection were documented.

Conclusions

Our experience shows that DMEK is a useful technique to treat endothelial graft failure following PK. Compared to repeat PK, DMEK-specific surgical complications and postsurgical management should be expected.