A Multicenter-Study Evaluating the Indications and Outcomes of Repeat Descemet’s Stripping
Endothelial Keratoplasty

Abstract

Purpose : Endothelial keratoplasty (EK) is a group of surgical procedures for managing corneal endothelial dysfunction. The most common is the Descemet’s stripping endothelial keratoplasty (DSEK). The procedure may be repeated in the event of a failed DSEK. There have been several reports examining various combinations of repeat keratoplasty techniques for failed grafts (full and partial-thickness). Since the number of repeat DSEK cases is typically low at any single center, our aim was to collaborate with the Eversight Eye Bank to establish a multicenter study to evaluate a large number of repeat DSEK cases. The goal of our study is to report the indcations and outcomes of the repeat DSEK procedures from multiple sites to provide a realistic assessment of the results.

Methods : We performed an IRB-approved, multicenter, retrospective chart review of patients who had a repeat DSEK following a prior failed DSEK. The Eversight Eye Bank provided detailed donor information including age, sex, pre- and post-cut corneal thickness, endothelial cell density, graft thickness and death to preservation time. Four different centers participated in the study (Loyola University, University of Illinois at Chicago, Verdier Eye Center and Arbor Center for Eye Care). Information extracted from the participant charts included recipient demographics, pre-op and post-op visual acuity, initial and repeat DSEK indications, number of glaucoma drops pre- and post-repeat DSEK, post-op endothelial cell counts, central corneal thickness and co-morbid ocular and systemic disease.

Results : A total of 24 patients who underwent repeat DSEK were identified among the four study sites. The average age was 67.5 years with a female-to-male ratio of 5:3. The average time from initial to repeat DSEK was 2 years. The most common indication for initial DSEK was Fuch’s endothelial dystrophy (N=8). The most common indication for repeat DSEK was late endothelial graft failure without rejection (N=8). Average pre-initial DSEK and post-repeat DSEK visual acuities were 20/300 and 20/77, respectively. The mean repeat donor graft thickness was 169 microns and the mean repeat donor endothelial cell count was 2722 cells/mm².

Conclusions : Our study represents the largest multi-center report on repeat DSEK outcomes to date. The results of the study may provide valuable information for surgeons when deciding to perform repeat DSEK cases.

This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.