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Descemet Stripping Automated Endothelial Keratoplasty After Failed Penetrating Keratoplasty

Jangi, Anisha A. MD; Ritterband, David C. MD; Wu, Elaine I. MD; Mehta, Veeral V.; Koplin, Richard S. MD; Seedor, John A. MD

doi: 10.1097/ICO.0b013e31823f78b3
Clinical Science

Purpose: To report the rate of graft dislocation, surgical anatomic success, and postsurgical complications associated with Descemet stripping automated endothelial keratoplasty (DSAEK) after previous primary failed penetrating keratoplasty (PK).

Methods: Institutional review board–approved, single-center, retrospective chart review study of 30 eyes of 30 patients with prior failed PK who underwent DSAEK with a minimum of 3 months follow-up. Primary outcomes measured included rates of anatomic success and failure, postoperative complications, lenticle size, visual acuity, intraocular pressure change, and a report of external factors that may affect success.

Results: Thirty eyes of 30 patients were identified. The primary dislocation rate was 16.7%. Five primary DSAEKs detached; 1 was successfully rebubbled in the office, 2 had repeat successful DSAEKs, and 2 failed on a second attempt and had a subsequent PK. Despite successful anatomic attachment, 1 eye had primary graft failure, 3 that cleared initially failed within 6 months, and 1 that successfully cleared had subsequent graft rejection resulting in failure at 6 months. The 2 eyes requiring PK were excluded from the visual outcomes analysis, leaving 28 eyes with successfully attached lenticles. At 3 months postoperatively, of the 28 eyes, 19 showed an improvement in visual acuity, 6 had no change in vision from preoperative data, and 1 had worsening of vision (anatomic attachment but endothelial failure). Two of the 28 eyes had no data at that time point.

Conclusions: DSAEK eyes after failed PK demonstrated improved vision with a low complication rate in a majority of patients. The graft dislocation rate and postoperative complications rates are comparable with the primary DSAEK dislocation rates in our own published series and in the literature.

*Department of Ophthalmology, The New York Eye and Ear Infirmary, New York, NY

New York Medical College, Valhalla, NY

Reprints: David C. Ritterband, Department of Ophthalmology, The New York Eye and Ear Infirmary, 310 E 14th St, New York, NY 10003 (e-mail:

The authors state that they have no proprietary interest in the products named in this article.

Received May 15, 2011

Accepted July 16, 2011

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