DSEK effective in eyes with failed PK grafts

PHILADELPHIA — Descemet's stripping endothelial keratoplasty is a viable alternative for patients with failed prior penetrating keratoplasty, according to a small study presented here.

Haresh Ailani

"The options for the corneal transplant surgeon are to do a full-thickness corneal transplant or to try one of the newer transplants, partial-thickness Descemet's stripping endothelial keratoplasty," Haresh Ailani, MD, said at the Wills Eye Institute Alumni Conference. "It can be done, and it's a great way of rehabilitating failed grafts."

The retrospective study included 19 patients with previous PK. Half the patients were pseudophakic with prior cataract surgery, and 48% had prior cataract surgery and glaucoma tube shunts or traps. One patient was phakic.

Results showed three dislocated grafts in nine patients with previous glaucoma surgery.

"This is most likely because of the fact that we have more complex eyes with more complex anatomy," Dr. Ailani said.

On postop day 1, four of five dislocated grafts were managed with re-bubbling; one patient underwent graft repositioning and reattachment.

All 19 patients had favorable visual outcomes. All grafts were clear and fully attached at a mean final follow-up of 5.4 months.

Patients with high astigmatism should not undergo DSEK after a failed PK, Dr. Ailani said.