Aims To evaluate techniques, outcomes and complications of endothelial keratoplasty (EK) without Descemet's stripping in eyes with previous penetrating keratoplasty (PK).

Methods A retrospective, consecutive analysis of patients who underwent EK in eyes with previous PK.

Results 33 eyes of 31 consecutive patients underwent EK without Descemet's stripping in eyes with previous PK. All 33 eyes were followed for an average of 14.2±4.4 months. The reason for EK was either graft rejection (n=9) or endothelial failure (n=24). 32/33 (97.0%) eyes remained clear at the last follow-up visit. Visual acuity improved in 28/33 (84.8%) patients with 19/28 (67.9%) of these patients having more than three lines of visual acuity improvement. The average postoperative vision in this group was 20/60 (range 20/25–20/100). Pre-cut donor tissue was used for all cases with an average thickness of 127 μm. Endothelial cell density declined by 35% at 3 months and was stable at 1 year. 2/33 (6%) eyes had graft dislocations. One eye was successfully treated by a re-bubble. The other case failed EK revision and required a repeat PK. No patients developed EK or PK graft failure/rejection.

Conclusion EK without Descemet's membrane stripping in eyes with previous PK graft failure/rejection is a valuable alternative to a repeat full thickness PK.