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Outcomes of Repeat Endothelial Keratoplasty in Patients With Failed Descemet Stripping Endothelial Keratoplasty

Kim, Peter MBBS(Hons), FRANZCO; Yeung, Sonia N. MD, PhD, FRCSC; Lichtinger, Alejandro MD; Amiran, Maoz D. MD; Shanmugam, Shobha V. MB; Iovieno, Alfonso MD; Slomovic, Allan R. MD, FRCSC; Rootman, David S. MD, FRCSC

doi: 10.1097/ICO.0b013e31823d1f03
Clinical Science

Purpose: To report the outcomes of repeat endothelial keratoplasty (EK) in patients with failed Descemet stripping endothelial keratoplasty (DSEK).

Methods: The clinical records of patients with failed DSEK who underwent repeat EK surgery at a single institution were reviewed.

Results: A total of 20 eyes of 20 patients (8 men and 12 women) were included. The mean age at initial DSEK surgery was 69.9 ± 11.9 years (range, 41–83 years). The causes of DSEK failure included progressive endothelial failure (8 eyes; 40%), primary graft failure (8 eyes; 40%), and endothelial rejection (4 eyes; 20%). The mean duration from primary DSEK to repeat EK was 13.1 ± 10.3 months (range, 2–33 months). Removal of the failed DSEK donor disc was performed in all eyes. Mean preoperative corrected distance visual acuity (logMAR) before repeat EK surgery was 1.76, and this improved to 0.5 (P < 0.001) at the final follow-up at 27 months. Three eyes had limited corrected distance visual acuity secondary to ocular comorbidities (age-related macular degeneration and advanced glaucomatous optic neuropathy).

Conclusions: Repeat EK in patients with DSEK failure is an effective treatment modality. This is the preferred management option compared with penetrating keratoplasty because the advantages of EK surgery are maintained with repeat EK surgery.

Department of Ophthalmology, Toronto Western Hospital, University of Toronto, Ontario, Canada.

Reprints: Peter Kim, Department of Ophthalmology, Toronto Western Hospital, University of Toronto, 399 Bathurst St, East Wing 6E 401, Toronto, Ontario M5T 2S8, Canada (e-mail:

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

M. D. Amiran is a recipient of the Schwartz Reisman Fellowship, Toronto, Canada for 2010–2011.

The authors have no financial or conflicting interests to disclose.

Received May 20, 2011

Accepted August 22, 2011

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