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  • DMEK an effective alternative for managing graft failure after PK

    Cornea/External Disease

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    This study assessed the outcomes and graft survival of Descemet membrane endothelial keratoplasty (DMEK) after failed penetrating keratoplasty (PK).

    Study design

    This single-center retrospective case series included 93 DMEK procedures performed in 84 eyes (77 patients) with failed PK. The main outcomes were corrected distance visual acuity (CDVA) and graft survival. Additionally, researchers performed a risk factor analysis and assessed rejection, rebubble, central corneal thickness (CCT) and endothelial cell loss.

    Outcomes

    Median CDVA improved from 0.7 logMAR at baseline to 0.3 logMAR at 3 months and 0.18 logMAR at 6 and 12 months. The risk of rebubble was higher with grafts that were larger in diameter than that of the previous PK (P=0.032). Researchers noted a slight increase in endothelial cell loss (31% to 47%) between 6 and 24 months.

    Overall, the probability of graft survival declined from 1 to 4 years (93% to 76%). Previous glaucoma filtration surgery was the only significant risk factor for failure (relative risk 7.1). The chance of immunologic rejection during the study was 1.7%.

    Limitations

    This study was limited by its retrospective nature. Cases were selected according to the surgeon’s preference for DSEK—or repeat PK instead of DMEK—in eyes with shallow anterior chamber, iris defects, aphakia or extensive synechiae. Surgical complications were not reported.

    Clinical significance

    In patients with failed PK, DMEK may offer a faster visual recovery and lower risk of rejection when compared with repeat PK or DSEK. However, 4-year graft survival rates were similar between patients who underwent DMEK, DSEK or repeat PK. Previous glaucoma filtration surgery, however, reduces graft survival.