Descemet stripping automated endothelial keratoplasty after 2 previously rejected femtosecond laser-assisted keratoplasties.

PURPOSE: To report on a patient with a welding flash burn with subsequent scarring and edema who twice underwent femtosecond laser-assisted keratoplasty (FLAK). Both grafts failed due to endothelial decompensation. He subsequently underwent successful Descemet stripping automated endothelial keratoplasty (DSAEK) under the second FLAK graft to decrease rejection risk and prevent further full-thickness keratoplasty.

METHODS

A 51-year-old man with a history of 2 FLAK procedures with subsequent graft failures likely from noncompliance with postoperative medications had diffuse microcystic edema with a visual acuity of counting fingers at 5 feet. The patient underwent DSAEK procedure 4 months after the second FLAK procedure.

RESULTS

No dehiscence occurred during second laser trephination of cornea. Sections of mild misalignment between the first and second FLAK graft trephinations were noted on optical coherence tomography. Post-DSAEK, the patient had a rapidly clearing, well-attached graft with mild temporal overlap of the graft-host interface. All sutures were removed from the overlying FLAK graft by 3 months after DSAEK (7 months after repeat FLAK). At 9 months post-DSAEK, the patient's uncorrected visual acuity was 20/40 and best spectacle-corrected visual acuity was 20/30.

CONCLUSIONS

Early secondary femtosecond laser trephination after first FLAK is possible even if the second graft is misaligned. A crescent remnant of the original graft was well-healed into the host cornea 7.5 months after the original surgery. The 3-month-old second FLAK graft was able to support a DSAEK surgery and rapid postoperative visual recovery. All sutures were removed from the cornea by 7 months after the second FLAK surgery.