Repeat Endothelial Keratoplasty Outcomes In Patients With Failed Deep Lamellar Endothelial Keratoplasty (DLEK)

1. Peter Kim
2. Alejandro Lichtinger
3. Sonia N. Yeung
4. Maoz D. Amiran
5. David S. Rootman

Toronto Western Hospital, Univeristy of Toronto, Toronto, Canada

Purpose: To report the outcomes of repeat endothelial keratoplasty (EK) in patients with previous failed deep lamellar endothelial keratoplasty (DLEK).

Methods: The clinical records of patients with failed previous DLEK surgery who had repeat EK surgery were reviewed.

Results: Nine eyes of 8 patients (2 males, 7 females) were included. The mean age at initial DLEK surgery was 71±8.5 years (range 59 to 80) and the duration to repeat EK was 50±10 months (range 33 to 63). Removal of the failed DLEK donor disc was performed in 6 eyes (66.7%) and in 3 eyes (33.3%), repeat EK was performed without removal.
The mean follow-up following repeat EK surgery was 22.6 months (range 3 to 44). Improvement in corneal clarity and visual acuity was obtained in all patients.
Four of 9 eyes (44.4%) had preoperative BCVA 20/100 or better compared to 8 of 9 eyes (88.9%) achieving BCVA 20/100 or better. One eye had BCVA of 20/300 secondary to advanced geographic atrophy.
No significant postoperative complications were noted following repeat EK surgeries.

Conclusion: Repeat EK in patients with late DLEK failure is effective in improving corneal clarity. Surgery may be performed with or without removal of the failed donor disc. Visual outcomes may be limited by co-existing ocular co-morbidities.