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Marianne O. Price, Anshu Arundhati, Francis W. Price, Jr.; Treatment of Failed Penetrating Keratoplasty with Endothelial Keratoplasty: Outcomes in 60 Consecutive Cases. Invest. Ophthalmol. Vis. Sci. 2011;52(14):1630.
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To assess outcomes of endothelial keratoplasty (EK), with or without stripping Descemet membrane, in eyes with failed penetrating keratoplasty (PKP).
The outcomes of 60 consecutive patients with failed PKP who underwent EK were retrospectively analyzed. Surgical technique, complications, visual outcomes and graft survival were analyzed.
The main indications for the original PKP were Fuchs’ endothelial dystrophy (27), keratoconus (9) or psuedophakic/aphakic bullous keratopathy (9). Most patients had one previous failed PKP (42 eyes) while 12 had 2 previous and 6 had 3 previous failed PKPs. Thirty eyes (50%) had pre-existing glaucoma (9 with prior trabeculectomy and 12 with a previous shunt procedure). Thirteen patients (23%) had poor vision in the fellow eye and needed early visual rehabilitation. The EK graft diameter ranged from 8 to 9 mm and most EK grafts were oversized by about 1mm relative to the original PKP. Intraoperatively, Descemet’s membrane was not stripped in most cases (n=52, 87%). The most common complications were graft detachment (3 eyes, 5%), endothelial rejection (6 eyes, 10%) and graft failure (10 eyes, 17%). Five of the eyes with graft failure had a repeat graft (EK-3; PKP-2).
Compared with a standard PKP regraft, EK under a previous failed PKP can provide more rapid visual rehabilitation while minimizing the risk of any ocular surface complications. Stripping of Descemet membrane from the failed PKP only needs to be performed if the membrane has guttae or other abnormalities that might degrade vision; stripping is not necessary for EK adherence.
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