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Secondary Descemet Membrane Endothelial Keratoplasty After Failed Primary Descemet Membrane Endothelial Keratoplasty: Clinical Results

Yoeruek, Efdal MD; Bartz-Schmidt, Karl-Ulrich MD

doi: 10.1097/ICO.0b013e31828321c1
Clinical Science

Purpose: To evaluate the clinical outcome of a secondary Descemet membrane endothelial keratoplasty (DMEK) to manage graft failure after primary DMEK.

Methods: Retrospective analysis of graft failure after primary DMEK treated with a second DMEK. The clinical outcome was evaluated by comparing the pre- to postoperative best-corrected visual acuity (BCVA) after first and second DMEK.

Results: In 122 DMEKs performed, 6 patients were included because of nonclearing edema or graft detachment. Ten of 122 grafts failed, 8 had a second DMEK, and 6 had an adequate follow-up with visual potential to be included in the visual acuity analysis. All patients had Fuchs dystrophy as the underlying disease for the endothelial decompensation. Average time to the second surgery was 2.9 months (1–5 months). Mean follow-up after second DMEK was 3.3 months (1–6 months). BCVA was 0.63 ± 0.22 logarithm of the minimum angle of resolution (logMAR) preoperatively and decreased to 1.50 ± 0.28 logMAR after first surgery (mean follow-up, 2.9 months; P < 0.001). BCVA increased to 0.13 ± 0.05 after successful second DMEK (mean follow-up, 3.3 months; P < 0.001). All second DMEKs were successful.

Conclusions: To manage DMEK cases with graft failure, secondary DMEK may be a feasible procedure potentially resulting in full visual rehabilitation, as in primary DMEK. In the event of a DMEK graft failure, a secondary DMEK may be an effective back-up procedure because it may give a clinical outcome similar to that given after a primary DMEK.

Department of Ophthalmology, Eberhard-Karls University Tuebingen, Tuebingen, Germany.

Reprints: Efdal Yoeruek, University Eye Hospital, Centre of Ophthalmology, Eberhard-Karls University, Schleichstr 12, 72076 Tuebingen, Germany (e-mail:

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

Received September 17, 2012

Accepted December 13, 2012

Copyright © 2013 Wolters Kluwer Health, Inc. All rights reserved.