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Endothelial Keratoplasty Without Descemet Stripping After Failed Penetrating Keratoplasty

Heitor de Paula, Fernando MD; Kamyar, Roheena MD; Shtein, Roni M. MD, MS; Sugar, Alan MD; Mian, Shahzad I. MD

doi: 10.1097/ICO.0b013e31823f8c59
Clinical Science

Purpose: To evaluate outcomes of endothelial keratoplasty (EK) without Descemet membrane stripping for treatment of failed penetrating keratoplasty (PKP).

Methods: Retrospective cohort study of all eyes that underwent EK without Descemet membrane stripping for failed PKP at one institution between May 2008 and June 2010, with follow-up to 12 months. Main outcome measures were best-corrected visual acuity (BCVA), dislocation rate, and graft failure.

Results: Twenty-two eyes of 22 patients underwent non-Descemet stripping EK with a mean follow-up of 8.8 months (±3.41; range, 3–12 months). The mean preoperative BCVA was logarithm of the minimum angle of resolution (logMAR) 1.43 (±0.72; range, 0.3–3; Snellen, 20/537; N = 22). The mean postoperative BCVA was logMAR 0.97 (±0.88; range, 0–3; N = 21) at 1 month, 0.76 logMAR (±0.74; range, 0.1–3; N = 21) at 3 months, 0.75 (±0.77; range, 0–3; N = 17) at 6 months, and logMAR 0.55 (±0.38; range, 0.18–1; Snellen, 20/70; N = 9) at 1 year. Eight eyes (36.6%) had graft dislocations requiring one rebubbling procedure in 6 of 8 eyes and 2 rebubblings in the other 2 eyes. All grafts were successfully reattached. Graft failure occurred in 2 of 22 eyes (9%), with 1 eye (5%) undergoing repeat EK and 1 eye (5%) undergoing PKP.

Conclusions: EK without Descemet membrane stripping is an effective option for management of eyes with failed PKP and may be a preferable alternative to a repeat PKP.

*Department of Ophthalmology and Visual Sciences, W.K. Kellogg Eye Center, University of Michigan Medical School, Ann Arbor, MI

Department of Ophthalmology, Division of Cornea and External Disease, Santa Casa de São Paulo, São Paulo, Brazil.

Reprints: Shahzad I. Mian, Department of Ophthalmology and Visual Sciences, W.K. Kellogg Eye Center, University of Michigan Medical School, 1000 Wall St, Ann Arbor, MI 48105 (e-mail:

The authors have no financial or conflicts of interest to disclose.

Received January 11, 2011

Accepted June 17, 2011

Copyright © 2012 Wolters Kluwer Health, Inc. All rights reserved.