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.
- Corneal transplantation
- Descemet membrane
- Descemet membrane endothelial keratoplasty
- Descemet stripping endothelial keratoplasty
- posterior lamellar keratoplasty
- surgical technique
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Competing interests Dr G R J Melles is a consultant for D.O.R.C./Dutch Ophthalmic USA.
Ethics approval This study was conducted with the approval of the Institutional Review Board (IRB)/Informed Consent (IC). This study was conducted in compliance with the IRB and IC requirements, in adherence to the tenets of the Declaration of Helsinki, at the Netherlands Institute for Innovative Ocular Surgery (Study registration no N.05.14).
Patient consent Obtained.
Provenance and peer review Not commissioned; externally peer reviewed.