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Descemet Membrane Endothelial Keratoplasty for Failed Penetrating Keratoplasty

Visual Outcomes and Graft Survival

Pasari, Anand, MD*; Price, Marianne O., PhD*; Feng, Matthew T., MD; Price, Francis W. Jr, MD

doi: 10.1097/ICO.0000000000001763
Clinical Science

Purpose: To evaluate outcomes and graft survival of Descemet membrane endothelial keratoplasty (DMEK) for failed penetrating keratoplasty (PK).

Methods: Ninety-three DMEK procedures performed in 84 eyes of 77 patients with failed PK were retrospectively reviewed. The main outcomes were corrected distance visual acuity and graft survival assessed with Kaplan–Meier survival analysis and proportional hazards modeling taking follow-up into consideration.

Results: Sixty-nine eyes had 1 previous failed PK, 13 had 2, 1 had 3, and 1 had 4. Ten eyes had failed Descemet stripping endothelial keratoplasty (DSEK) performed under failed PK. Fourteen cases (15%) had previous glaucoma filtration surgery (9 trabeculectomy alone; 5 trabeculectomy and aqueous shunt). Median follow-up was 21 months (range, 1 month to 7 years). Median Snellen corrected distance visual acuity improved from 20/100 preoperatively (range, 20/30 to count fingers) to 20/30 at 6 months postoperatively (n = 73; range, 20/20–20/200). Rebubbling rates were 53% when the diameter of the DMEK graft was oversized, 27% when same sized, and 33% when undersized relative to that of the previous PK graft. Two grafts (2%) experienced an immunologic rejection episode, and 15 (16%) failed, including 5 primary/early failures and 10 late failures. Previous glaucoma surgery was the only significant risk factor for failure (relative risk, 7.1; 95% confidence interval, 2.1–37.0). The 1-, 2-, and 3-year graft survival rates were 96%, 89%, and 89% without versus 78%, 53%, and 39% with previous glaucoma surgery.

Conclusions: Treatment of failed PK with DMEK produced similar 4-year survival (76%) and better visual outcomes than previously reported with Descemet stripping endothelial keratoplasty or an initial PK regraft.

*Cornea Research Foundation of America, Indianapolis, IN; and

Price Vision Group, Indianapolis, IN.

Correspondence: Marianne O. Price, PhD, Cornea Research Foundation of America, 9002 N. Meridian St, Suite 212, Indianapolis, IN 46260 (e-mail:

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

Received June 20, 2018

Accepted August 09, 2018

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