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. 2026 Jan 1;45(1):29-35.
doi: 10.1097/ICO.0000000000003759. Epub 2024 Nov 22.

Characteristics and Outcomes of Descemet Membrane Endothelial Keratoplasty for Treatment of Failed Endothelial Keratoplasty

Marianne O Price  1 , Luis Valdes Navarro  2 , Matthew T Feng  3 , Anjulie Gang  3 , David A Price  3 , Francis W Price Jr  3
Affiliations

Characteristics and Outcomes of Descemet Membrane Endothelial Keratoplasty for Treatment of Failed Endothelial Keratoplasty

Marianne O Price et al. Cornea. .

Abstract

Purpose: To evaluate Descemet membrane endothelial keratoplasty (DMEK) for failed endothelial keratoplasty (EK).

Methods: We reviewed 362 consecutive DMEK cases for failed EK (Descemet stripping endothelial keratoplasty (DSEK) or DMEK), 118 for early EK failure, and 244 for late failure in 333 eyes of 323 patients without penetrating keratoplasty. Rejection and graft survival rates were assessed with Kaplan-Meier analysis.

Results: Overall, 85% of cases had 1 prior EK and 15% had 2 to 5. The rate of medically or surgically managed glaucoma was 21% in eyes with 1 failed EK, 51% in eyes with 2, and 80% in eyes with ≥3, P <0.0001. The mean postoperative corrected visual acuity was 20/25 ± 1 line at 1 and 5 years in eyes without vision-limiting comorbidity. The 5-year rejection episode rate was 4%. One- and 5-year survival rates of DMEK regrafts for early failure of an initial EK were 98% and 94%, respectively. One- and 5-year survival rates among all cases of DMEK for EK failure were 96% and 91% in eyes not treated for glaucoma preoperatively, 88% and 81% in eyes with medically managed glaucoma, and 88% and 30% in eyes with a trabeculectomy or tube shunt.

Conclusions: DMEK for failed EK provided rapid visual rehabilitation with low risk of rejection. Graft survival was associated with glaucoma status and original indication for keratoplasty, with Fuchs dystrophy having the most favorable prognosis. Survival rates were highest in eyes treated for early failure of an initial EK.

Keywords: DSAEK; Descemet membrane endothelial keratoplasty; Descemet stripping endothelial keratoplasty; Fuchs dystrophy; bullous keratopathy; endothelial cell loss; endotheliitis; glaucoma; graft survival; iridocorneal endothelial syndrome; secondary corneal edema.

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Conflict of interest statement

The authors have no funding or conflicts of interest to disclose.

Figures

FIGURE 1.
FIGURE 1.
Regraft success over time by the 2 main original indications for keratoplasty.
FIGURE 2.
FIGURE 2.
Regraft success over time by preoperative glaucoma status (prior tube shunt, prior trabeculectomy, medically managed glaucoma, or no glaucoma treatment).
See this image and copyright information in PMC

References

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