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.