Alternative surgical strategy for DSAEK after failed PK shows promise

Surgeons are increasingly using endothelial keratoplasty for indications other than Fuchs dystrophy and pseudophakic or aphakic bullous corneal edema. However, the complication rate after Descemet's stripping automated endothelial keratoplasty (DSAEK) for failed penetrating keratoplasty (PK) has been reported to be much higher than in Fuchs dystrophy or pseudophakic bullous keratopathy. In this study, investigators use a specific surgical strategy to address failed PK with DSAEK.

In 17 eyes treated with DSAEK for failed PK, they used a DSAEK graft that was the same size or smaller than the PK diameter to prevent graft detachment. OCT with careful slit-lamp examination was used to guide the choice of graft diameter, and this was followed by the standard technique of Descemet's stripping and peripheral bed scraping.

At an average follow-up of 16 months, only one detachment occurred, which required air reinjection, for a 5.8 percent detachment rate. There were no cases of pupillary block or primary graft failure. However, in an accompanying editorial, Francis W. Price, MD, Marianne O. Price, MD and Anshu Arundhati, MD, raise concerns about the authors recommendation to strip Descemet membrane and roughen the peripheral stroma since this could weaken the wound further.

The authors conclude that these results confirm DSAEK's ability to restore clarity to failed PK grafts and that the use of a specific surgical strategy can minimize early complications. However, they recommend a randomized, prospective study comparing surgical techniques to definitively confirm their value.