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Outcomes of Repeat Endothelial Keratoplasty in Patients With Failed Deep Lamellar Endothelial Keratoplasty

Kim, Peter MBBS(Hons), FRANZCO; Brodbaker, Elliott MD; Lichtinger, Alejandro MD; Yeung, Sonia N MD, PhD, FRCS(C); Bahar, Irit MD; Iovieno, Alfonso MD; Amiran, Maoz D MD; Rootman, David S MD, FRCS(C)

doi: 10.1097/ICO.0b013e31821522b4
Clinical Science

Purpose: To report the outcomes of repeat endothelial keratoplasty (EK) in patients with previous failed deep lamellar endothelial keratoplasty (DLEK).

Methods: This retrospective interventional case series involved the review of clinical records of patients with failed DLEK surgery who underwent repeat EK surgery.

Results: Ten eyes of 9 patients (2 men and 7 women) were included. The mean age at initial DLEK surgery was 71.2 ± 8.0 years (range, 59–80 years), and the duration to repeat EK was 47 ± 14.3 months (range, 16–63 months). Removal of the failed DLEK donor disc was performed in 7 eyes (70%); in 3 eyes (30%), repeat EK was performed without removal of the failed donor disc. The mean follow-up after repeat EK surgery was 21.7 months (range, 3–44 months). Improvements in corneal clarity and visual acuity were obtained in all eyes. Mean preoperative logarithm of the minimum angle of resolution (logMAR) best-corrected visual acuity (BCVA) was 1.46 (20/577; range, 20/100 to counting fingers) and improved to 0.64 (20/87; range, 20/30 to 20/300) at the final follow-up (P = 0.03). Four eyes had limited BCVA secondary to ocular comorbidites, including age-related macular degeneration, cystoid macular edema, and advanced glaucomatous optic neuropathy. No significant postoperative complications were noted after repeat EK surgeries.

Conclusions: Repeat EK in patients with late DLEK failure is effective in improving corneal clarity and is a viable alternative to penetrating keratoplasty (PK). Surgery may be performed with or without removal of the failed donor disc. Visual outcomes may be limited by the existence of ocular comorbidities.

From the Department of Ophthalmology, Toronto Western Hospital, University of Toronto, Toronto, Canada.

Received for publication December 13, 2010; revision received January 25, 2011; accepted February 5, 2011.

Dr. Yeung is supported by the E.A. Baker Fellowship Fund Grant from the Canadian National Institute for the Blind.

The authors have no financial or conflicting interests to disclose.

Reprints: Peter Kim, Department of Ophthalmology, Toronto Western Hospital, Toronto M5T 2S8, Canada (e-mail:

Copyright © 2011 Wolters Kluwer Health, Inc. All rights reserved.