Aim To evaluate the outcomes of ultrathin Descemet stripping automated endothelial keratoplasty (UT-DSAEK) performed in eyes after failure of primary Descemet membrane endothelial keratoplasty (DMEK).
Methods This was a retrospective, non-comparative interventional case series done in a tertiary care hospital. The study group included 21 eyes of patients which underwent UT-DSAEK following the failure of primary DMEK. Outcome measures included best spectacle-corrected visual acuity (BSCVA) and endothelial cell density (ECD) both recorded 6 and 12 months postoperatively as well as central graft thickness (CGT) measured 6 months after UT-DSAEK.
Results When considering only eyes without comorbidities (17 of 21), 12 months after UT-DSAEK, BSCVA was ≥20/25 in 12/13 (92%) eyes and ≥20/20 in 4/13 (30%) eyes. Mean ECD loss rate was 38.9% at 12 months postoperatively (range 8%–57%). Six months postoperatively, CGT averaged at 81±34 µm (range 34–131 µm). No intraoperative complications were recorded. Postoperatively, one patient (no. 8) had graft wrinkles that were fixed 2 days following UT-DSAEK. Four patients have developed intraocular lens (IOL) opacification, and two of them underwent IOL exchange. No other postoperative complications were recorded.
Conclusions UT-DSAEK is instrumental in the management of primary DMEK graft failure, allowing visual rehabilitation which is comparable with that of repeat DMEK.
- Lamellar Keratoplasty
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Funding Massimo Busin receives reimbursement of travel and lodging expenses as well as royalties from Moria (Antony, France). No other author has any financial interest to disclose.
Competing interests MB receives reimbursement of travel and lodging expenses as well as royalties from Moria (Antony, France).
Ethics approval Comitato Etico Ospedali Privati Forlì.
Provenance and peer review Not commissioned; externally peer reviewed.
Patient consent Not required.
Contributors MB: design and conduct of the study, management; SGr, PL, YN, RS, SGu, LM, MB: collection; SGr, YN, MB: analysis and interpretation of the data, and preparation of the manuscript.
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