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Back-up procedure for graft failure in Descemet Membrane Endothelial Keratoplasty (DMEK)
  1. Isabel Dapena,
  2. Lisanne Ham,
  3. Chantal van Luijk,
  4. Jacqueline van der Wees,
  5. Gerrit R J Melles
  1. Netherlands Institute for Innovative Ocular Surgery, Netherlands
  1. * Corresponding author; email: melles{at}


Purpose: 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-randomized prospective clinical study.

Methods: A first group of 50 cases with Fuchs endothelial dystrophy underwent DMEK. Two to five weeks after the DMEK, ten cases showed no corneal clearance, so that a secondary DSEK was performed. To evaluate the latter eyes, 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, since it may give a clinical outcome similar to that after a primary DSEK. Especially during the surgeon's learning curve, patient information may not only be directed towards DMEK, but also DSEK visual outcomes.

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