Abstract
Purpose :
Repeat Descemet’s stripping automated endothelial keratoplasty (DSAEK) surgery to replace a failed DSAEK graft has been reported as a successful method to achieve visual recovery. However, there are not many studies that compare the outcomes of repeat DSAEK vs replacement with Descemet membrane endothelial keratoplasty (DMEK). In this study we aim to evaluate and compare the clinical outcomes of DSAEK vs DMEK surgery for failed DSAEK.
Methods :
We retrospectively reviewed a consecutive series of patients from 1/2007 to 5/2018 that received either a DSAEK graft or a DMEK graft for failed DSAEK in which the initial DSAEK was performed for Fuchs Dystrophy. Graft failures, rejections, best spectacle-corrected visual acuity (BSCVA) and 6 month postoperative endothelial cell loss (ECL) was recorded. Eyes in which the initial DSAEK surgery was in the setting of a glaucoma filtration tube, trabeculectomy, anterior chamber IOL, other complex anterior segment anatomy, and patients lost to follow-up were excluded from the study. Students t-test and a Fishers exact test was used for statistical analysis.
Results :
A total of 40 eyes with replacement grafts for a failed DSAEK were evaluated. 22 eyes had a repeat DSAEK and 18 eyes received a DMEK graft. Rejections in repeat DSAEK and DMEK were found in 2 eyes (9.1%) and 0 eyes respectively, P=0.49. Late graft failures were found in 4 eyes for repeat DSAEK (18.2%) and 1 eye for DMEK (5.6%), P=0.36. Six month ECL for repeat DSAEK and replacement with DMEK was 27.3%±21.9% and 43.3%±15.5%, P=0.046. Best postoperative BSCVA attained from initial DSAEK compared to replacement with DMEK was 20/25 and 20/28 respectively, P=0.43.
Conclusions :
DMEK for failed DSAEK gave similar best postoperative BSCVA compared to the initial DSAEK, however repeat DSAEK had superior 6 month ECL. Although not statistically significant, DMEK for failed DSAEK was associated with a reduced risk of graft rejection and late graft failure. Graft rejections carry the risk of leading to subsequent graft failure which should be considered, along with the complexity of the anterior chamber, when deciding how to replace a failed DSAEK graft.
This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.