Descemet Membrane Endothelial Keratoplasty Under Failed Penetrating Keratoplasty Without Host Descemetorhexis for the Management of Secondary Graft Failure

Abstract

Purpose: To evaluate the safety and efficacy of the treatment of secondary graft failure in penetrating keratoplasty (PK) by performing Descemet membrane endothelial keratoplasty (DMEK) without host descemetorhexis.Methods: This is a retrospective case series study of 8 eyes from 8 patients who underwent non host Descemet membrane stripping DMEK surgery under a previously failed PK. The DMEK graft diameter was either matched or 0.25 to 0.5 mm undersized in relation to the PK diameter. Six-month postoperative data are presented. Primary outcome measures were safety and anatomical success.Results: No intraoperative complications were registered. Postoperatively, 1 case developed a PK host-donor junction dehiscence in relation to a previous early suture removal, requiring PK resuturing and DMEK rebubbling. Only 1 additional case required DMEK rebubbling. No primary graft failure was detected, and all cases achieved full PK transparency within 2 weeks. Corrected distance visual acuity improved from a median of counting fingers (CF-0.2) to 0.57 (0.05-0.7). Median central corneal thickness improved from 650.5 (497-897) to 464 (372-597) μm. Median endothelial cell density was 1080 (581-2043) cells/mm. Rebubbling rate (25%) was lower than that previously reported. All patients had extensive preoperative ocular comorbidity.Conclusions: DMEK under PK without host descemetorhexis is a feasible surgical alternative for the treatment of graft failure after PK. It is associated with equivalent levels of efficacy and safety compared with Descemet membrane stripping DMEK techniques but simplifies the surgical procedure and avoids potential intraoperative complications associated with Descemet stripping. Further studies with a larger sample and a longer follow-up are necessary to confirm our preliminary outcomes.