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Comparison of repeat penetrating keratoplasty, DSAEK and DMEK for the management of endothelial failure of previous PK
PURPOSE: To compare the clinical outcomes of repeat PK, DSAEK-on-PK or DMEK-on-PK for the management of endothelial failure of previous penetrating keratoplasty. DESIGN: Retrospective, interventional consecutive case series. PARTICIPANTS: 104 consecutive eyes of 100 patients requiring a second kerat...
Autores principales: | , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Nature Publishing Group UK
2023
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10686404/ https://www.ncbi.nlm.nih.gov/pubmed/37268770 http://dx.doi.org/10.1038/s41433-023-02561-5 |
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author | Roberts, Harry W. de Benito-Llopis, Laura |
author_facet | Roberts, Harry W. de Benito-Llopis, Laura |
author_sort | Roberts, Harry W. |
collection | PubMed |
description | PURPOSE: To compare the clinical outcomes of repeat PK, DSAEK-on-PK or DMEK-on-PK for the management of endothelial failure of previous penetrating keratoplasty. DESIGN: Retrospective, interventional consecutive case series. PARTICIPANTS: 104 consecutive eyes of 100 patients requiring a second keratoplasty for endothelial failure of their primary penetrating keratoplasty performed between September 2016 and December 2020. INTERVENTION: Repeat keratoplasty. MAIN OUTCOME MEASURES: Survival and visual acuity at 12 and 24 months, rebubbling rate and complications. RESULTS: Repeat PK was performed in 61/104 eyes (58.7%), DSAEK-on-PK was performed in 21/104 eyes (20.2%) and DMEK-on-PK was performed in 22/104 eyes (21.2%). Failure rates in the first 12 and 24 months were 6.6% and 20.6% for repeat PKs compared to 19% and 30.6% for DSAEK and 36.4% and 41.3% for DMEK. For those grafts surviving 12 months, the chances of surviving to 24 months were greatest for DMEK-on-PK at 92% vs 85% each for redo PK and DSAEK-on-PK. Visual acuity at one year was logMAR 0.53 ± 0.51 in the redo PK group, 0.25 ± 0.17 for DSAEK-on-PK and 0.30 ± 0.38 for DMEK-on-PK. 24-month outcomes were 0.34 ± 0.28, 0.08 ± 0.16, and 0.36 ± 0.36 respectively. CONCLUSIONS: DMEK-on-PK has a greater failure rate in the first 12 months than DSAEK-on-PK which has a greater failure rate than redo PK. However, the 2-year survival rates in our series for those already surviving 12 months were greatest for DMEK-on-PK. There was no significant difference in visual acuity at 12 or 24 months. Careful patient selection is needed by experienced surgeons to determine which procedure to offer to patients. |
format | Online Article Text |
id | pubmed-10686404 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2023 |
publisher | Nature Publishing Group UK |
record_format | MEDLINE/PubMed |
spelling | pubmed-106864042023-11-30 Comparison of repeat penetrating keratoplasty, DSAEK and DMEK for the management of endothelial failure of previous PK Roberts, Harry W. de Benito-Llopis, Laura Eye (Lond) Article PURPOSE: To compare the clinical outcomes of repeat PK, DSAEK-on-PK or DMEK-on-PK for the management of endothelial failure of previous penetrating keratoplasty. DESIGN: Retrospective, interventional consecutive case series. PARTICIPANTS: 104 consecutive eyes of 100 patients requiring a second keratoplasty for endothelial failure of their primary penetrating keratoplasty performed between September 2016 and December 2020. INTERVENTION: Repeat keratoplasty. MAIN OUTCOME MEASURES: Survival and visual acuity at 12 and 24 months, rebubbling rate and complications. RESULTS: Repeat PK was performed in 61/104 eyes (58.7%), DSAEK-on-PK was performed in 21/104 eyes (20.2%) and DMEK-on-PK was performed in 22/104 eyes (21.2%). Failure rates in the first 12 and 24 months were 6.6% and 20.6% for repeat PKs compared to 19% and 30.6% for DSAEK and 36.4% and 41.3% for DMEK. For those grafts surviving 12 months, the chances of surviving to 24 months were greatest for DMEK-on-PK at 92% vs 85% each for redo PK and DSAEK-on-PK. Visual acuity at one year was logMAR 0.53 ± 0.51 in the redo PK group, 0.25 ± 0.17 for DSAEK-on-PK and 0.30 ± 0.38 for DMEK-on-PK. 24-month outcomes were 0.34 ± 0.28, 0.08 ± 0.16, and 0.36 ± 0.36 respectively. CONCLUSIONS: DMEK-on-PK has a greater failure rate in the first 12 months than DSAEK-on-PK which has a greater failure rate than redo PK. However, the 2-year survival rates in our series for those already surviving 12 months were greatest for DMEK-on-PK. There was no significant difference in visual acuity at 12 or 24 months. Careful patient selection is needed by experienced surgeons to determine which procedure to offer to patients. Nature Publishing Group UK 2023-06-02 2023-12 /pmc/articles/PMC10686404/ /pubmed/37268770 http://dx.doi.org/10.1038/s41433-023-02561-5 Text en © The Author(s) 2023 https://creativecommons.org/licenses/by/4.0/Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) . |
spellingShingle | Article Roberts, Harry W. de Benito-Llopis, Laura Comparison of repeat penetrating keratoplasty, DSAEK and DMEK for the management of endothelial failure of previous PK |
title | Comparison of repeat penetrating keratoplasty, DSAEK and DMEK for the management of endothelial failure of previous PK |
title_full | Comparison of repeat penetrating keratoplasty, DSAEK and DMEK for the management of endothelial failure of previous PK |
title_fullStr | Comparison of repeat penetrating keratoplasty, DSAEK and DMEK for the management of endothelial failure of previous PK |
title_full_unstemmed | Comparison of repeat penetrating keratoplasty, DSAEK and DMEK for the management of endothelial failure of previous PK |
title_short | Comparison of repeat penetrating keratoplasty, DSAEK and DMEK for the management of endothelial failure of previous PK |
title_sort | comparison of repeat penetrating keratoplasty, dsaek and dmek for the management of endothelial failure of previous pk |
topic | Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10686404/ https://www.ncbi.nlm.nih.gov/pubmed/37268770 http://dx.doi.org/10.1038/s41433-023-02561-5 |
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