Back-up procedure for graft failure in Descemet membrane endothelial keratoplasty (DMEK)

Aim To evaluate the efficacy of a secondary Descemet stripping endothelial keratoplasty (DSEK) as a back-up procedure for managing graft failure after primary Descemet membrane endothelial keratoplasty (DMEK). Design Non-randomised prospective clinical study. Methods A first group of 50 cases with Fuchs endothelial dystrophy underwent DMEK. Two to five weeks after the DMEK, 10 cases showed no corneal clearance, so a secondary DSEK was performed. To evaluate the eyes of these 10 cases, best corrected visual acuity (BCVA) and endothelial cell density at 6 and 12 months were used as outcome parameters. Results At 6 months after secondary DSEK, 87% of the cases had a BCVA of ≥20/40 (≥0.5) and one eye reached 20/25 (≥0.8). Donor DSEK grafts endothelial cell densities averaged 2617±152 cells/mm2 before surgery, 1510±799 cells/mm2 at 6 months and 1602±892 cells/mm2 at 12 months after surgery. Conclusion In the event of a DMEK graft failure, a secondary DSEK may be an effective back-up procedure, as it may give a clinical outcome similar to that after a primary DSEK. Particularly during the surgeon's learning curve, patient information may be provided not only on visual outcomes after DMEK, but also after DSEK. Trial registration number NCT00521898.

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