Descemet stripping automated endothelial keratoplasty (DSAEK) versus repeat penetrating keratoplasty (PKP) to manage eyes with failed corneal graft

BACKGROUND: Failed corneal graft management is a challenge. Descemet stripping automated endothelial keratoplasty (DSAEK) and repeat penetrating keratoplasty (PKP) are two options. Only two studies have compared outcomes of DSAEK and PKP in the management of a failed graft. OBJECTIVE: To compare the visual outcomes, changes in intraocular pressure (IOP) and complications in eyes with failed corneal grafts that were subsequently managed with DSAEK and PKP. DESIGN: Retrospective cohort study. SETTINGS: Tertiary eye hospital of central Saudi Arabia. PATIENTS AND METHODS: A retrospective chart review was performed for cases managed between 2007 and 2012. Data were collected on the best-corrected visual acuity (BCVA) before and at day 1, 1 week, 4 weeks, 12 weeks, and 24 weeks after intervention. BCVA was compared in patients managed with DSAEK or PKP. Intra- and postoperative complications were compared in both groups. MAIN OUTCOME MEASURES: Clear graft, vision at last follow up, complications. RESULTS: There were 15 eyes in the DSAEK group and 30 in the PKP group. The causes of previously failed PKP differed between groups. BCVA at 6 months after repeat surgeries was 20/20 to 20/40 in 4 (27%) eyes in the DSAEK group and in 8 (27%) eyes in the PKP group. The IOP at 6 months was statistically significantly higher in the DSAEK group than the PKP group (P=.006). In DSAEK group, one graft rejection occurred in one eye and graft dislocation in another eye. Seven eyes in PKP group had signs of graft rejection that regressed in 5 eyes following medical management. CONCLUSIONS: DSAEK and PKP for previously failed corneal graft resulted in similar BCVA 6 months after repeat surgery. However, the visual outcomes were less promising with both types of surgeries. The lower complication rate and surgical ease may favor DSAEK over PKP in managing failed grafts. LIMITATIONS: Small sample, retrospective study.