Visual Outcomes of Repeat Versus Primary Descemet Stripping Automated Endothelial Keratoplasty—A Paired Comparison

Purpose: To compare the results of repeat Descemet stripping automated endothelial keratoplasty (DSAEK) with those of primary DSAEK. Materials and Methods: This retrospective study consisted of all consecutive eyes that underwent one or more repeat DSAEK surgeries after primary DSAEK performed at Villa Serena–Villa Igea Private Hospitals (Forlì, Italy) between January 2005 and June 2015. A paired comparison between the outcomes of primary and the second DSAEK was performed. Main outcome measures included best recorded best spectacle-corrected visual acuity (BSCVA), postoperative endothelial cell loss (ECL), and refractive error. Results: Of 1413 procedures, 51 eyes were included in the final analysis. Indications for primary DSAEK included pseudophakic bullous keratopathy (n = 21), Fuchs endothelial dystrophy (n = 20), failed penetrating keratoplasty (n = 9), and trauma (n = 1). Indications for repeat DSAEK were slowly progressive ECL (n = 35), endothelial rejection (n = 15), and host–graft interface abnormalities (n = 1). Preoperative BSCVA (logarithm of the minimum angle of resolution 1.23 ± 0.8 vs. 1.38 ± 0.6, P = 0.29) and best postoperative BSCVA (logarithm of the minimum angle of resolution 0.32 ± 0.44 vs. 0.34 ± 0.49, P = 0.70) did not differ significantly between the 2 groups. ECLs for primary and repeat DSAEK at 1 (46% ± 16% vs. 40% ± 18%, P = 0.22) and 2 years (50% ± 18% vs. 44% ± 2%, P = 0.33) were also similar. The mean postoperative spherical equivalent did not differ significantly between the 2 groups (−0.01 ± 1.9 vs. −0.5 ± 1.6, P = 0.08) nor did the absolute astigmatic error (1.6 ± 1 vs. 1.8 ± 1.2, respectively, P = 0.17). Conclusions: After the failure of a primary DSAEK graft, a subsequent DSAEK can yield visual outcomes and ECL rates that are comparable with those of primary DSAEK.