Clinical Outcomes of Repeat Descemet Membrane Endothelial Keratoplasty After Graft Failure

Achraf Laouani; Indrė Vasiliauskaitė; Vincent J A Bourgonje; Mohamed Ghaly; Charlotte Lanser; Isabel van Lieshout; Lamis Baydoun; Viridiana Kocaba; Gerrit R J Melles; Silke Oellerich

doi:10.1097/ICO.0000000000003622

Clinical Outcomes of Repeat Descemet Membrane Endothelial Keratoplasty After Graft Failure

Cornea. 2024 Jul 9. doi: 10.1097/ICO.0000000000003622. Online ahead of print.

Authors

Achraf Laouani^{1

2}, Indrė Vasiliauskaitė^{1

2}, Vincent J A Bourgonje^{1

2}, Mohamed Ghaly^{1

2}, Charlotte Lanser^{1

2}, Isabel van Lieshout^{1

2}, Lamis Baydoun^{1

3

4}, Viridiana Kocaba^{1

2}, Gerrit R J Melles^{1

2

5}, Silke Oellerich^{1

6

7}

Affiliations

¹ Netherlands Institute for Innovative Ocular Surgery, Rotterdam, the Netherlands.
² Melles Cornea Clinic, Rotterdam, the Netherlands.
³ Department of Ophthalmology, University Eye Hospital Munster, Munster, Germany.
⁴ ELZA Institute, Dietikon/Zurich, Switzerland.
⁵ Amnitrans EyeBank Rotterdam, Rotterdam, the Netherlands.
⁶ Department of Ophthalmology, Universitair Ziekenhuis Brussel, Brussel, Belgium; and.
⁷ Vrije Universiteit Brussel (VUB), Jette, Belgium.

PMID: 38981047
DOI: 10.1097/ICO.0000000000003622

Abstract

Purpose: To evaluate the clinical outcomes after repeat Descemet membrane endothelial keratoplasty (DMEK) for technical failure (TF) and secondary graft failure (SGF).

Methods: Retrospective analysis of 49 eyes that underwent repeat DMEK either for TF (ie, persistent graft detachment, n = 24) or for SGF (ie, late endothelial graft failure, n = 25). Surgery indications for primary DMEK were Fuchs endothelial corneal dystrophy (FECD, 80%) and bullous keratopathy (BK, 20%). Main outcome measures were best-corrected visual acuity (BCVA), endothelial cell density (ECD), corneal backscattering, pachymetry, and graft survival. Outcomes were compared with an age-matched control group of 49 primary DMEK eyes.

Results: Logarithm of the minimum angle of resolution BCVA improved from 0.92 ± 0.6 before to 0.20 ± 0.3 at 1 year after repeat DMEK with better outcomes for eyes with TF than those with SGF (P = 0.046). Donor ECD decreased from 2618 ± 171 cells/mm2 before to 1247 ± 422 cells/mm2 at 1 year postoperatively, with no difference between technical TF and SGF eyes (P > 0.05). One-year BCVA and ECD outcomes were better in the control group than in the repeat DMEK group (P < 0.05). Five-year graft survival probability after repeat DMEK was better for TF than for SGF eyes (100% vs. 75%, P = 0.010) and better for eyes with FECD than BK as primary indication for surgery (92% vs. 65%, P = 0.042).

Conclusions: Repeat DMEK gives acceptable clinical outcomes especially when performed for TF in the early period after primary DMEK. Long-term graft survival probability after repeat DMEK is comparable to primary DMEK for FECD eyes, whereas BK eyes may show an elevated risk to develop graft failure again.