Descemet stripping automated endothelial keratoplasty under failed penetrating keratoplasty: a surgical strategy to minimize complications.

PURPOSE: To report early complications of Descemet stripping automated endothelial keratoplasty (DSAEK) to treat late endothelial failure after penetrating keratoplasty (PK) using a specific surgical strategy.

DESIGN: Retrospective analysis of a prospectively collected dataset.

METHODS: All 17 eyes with a preoperative diagnosis of failed penetrating keratoplasty graft were identified out of a total pool of 793 eyes that had received DSAEK for endothelial dysfunction in a prospective Institutional Review Board-approved study of endothelial keratoplasty. A standard surgical strategy of careful slit-lamp examination and preoperative optical coherence tomography (OCT) to determine optimal DSAEK graft diameter was combined with undersized Descemet stripping and peripheral bed scraping.

RESULTS: A total of 17 eyes in 16 patients were identified. The DSAEK graft size ranged from 7.0 to 8.0 mm, with all DSAEK graft diameters less than or equal to the PK diameter. The average follow-up was 16 months (range 2-38 months). All PK grafts cleared and the visual acuity improved in all patients. There were no cases of pupillary block or primary graft failure. There was 1 dislocation (5.9%). The dislocation occurred in an eye with aniridia, prior trabeculectomy, and scleromalacia with postoperative hypotony from a wound leak.

CONCLUSION: DSAEK for failed PK using DSAEK grafts with a diameter less than or equal to the PK diameter allowed improved vision with a low complication rate. Preoperative OCT of posterior PK contour can aid in graft diameter selection.