1. Endothelial keratoplasty in failed grafts
Pravin K Vaddavalli
Cornea & Refractive surgery Service
LV Prasad Eye Institute
Hyderabad, India
The authors have no financial interests to disclose

2. Endothelial keratoplasty evolution
Descemets Membrane Endothelial Keratoplasty (DMEK)
Posterior Lamaellar keratoplasty (PLK)
Deep Lamellar Endothelial Keratoplasty (DLEK)
Descemet’s Stripping Endothelail Keratoplasty (DSEK)
Descemets Stripping Automated Endothelial Keratoplasty (DSAEK)

3. Indications Fuchs’ endothelial dystrophy
Pseudophakic and Aphakic corneal edema
Endothelial decompensation
Failed grafts
ICE syndrome
Unsalvageable Descemet’s membrane detachment
TASS
Corneal trauma
Bee sting
Birth trauma
PPMD/ CHED
Terry MA, Shamie N, Chen ES, Hoar KL, Friend DJ Endothelial keratoplasty a simplified technique to minimize graft dislocation, iatrogenic graft failure, and pupillary block. Ophthalmology Jul;115(7):
Bahar I, Kaiserman I, Buys Y, Rootman D Descemet's stripping with endothelial keratoplasty in iridocorneal endothelial syndrome. Ophthalmic Surg Lasers Imaging Jan-Feb;39(1):54-6

4. Indications for endothelial keratoplasty in our first 100 cases
Relatively poor outcomes for DSAEK following failed grafts
Covert DJ, Koenig SB. Descemet stripping and automated endothelial keratoplasty (DSAEK) in eyes with failed penetrating keratoplasty. Cornea Jul;26(6):692-6t

5. Purpose
Evaluate the outcomes of Descemets stripping endothelial keratoplasty (DSEK) in eyes with failed grafts
Design
Retrospective analysis of all cases of failed grafts undergoing DSEK in a tertiary eye hospital

6. Methods Retrospective case analysis
First 100 consecutive cases of DSEK by single surgeon (PKV)
All patients with failed grafts undergoing DSEK
Variables
Demographic data
Improvement of best corrected visual acuity
Endothelial cell density
Complications

7. Indications for penetrating keratoplasty
Results
Indications for penetrating keratoplasty
M:F :: 14:8
Mean age 30.8 ± 19 yrs ( yrs)
Indication for PK – Infection, CHED
Lens status
Pseudophakic
Aphakic
Phakic 9 1 12

8. Results Mean follow up - 6.13 months (1 month – 12 months)
Endothelial cell density: 38.3% endothelial cell loss at 1 month
Donor
1 month
3 months
6 months
12 months
2939
1808
1660
1553
1488

9. Results
Best corrected visual acuity (logMAR) improvement from pre op values clinically significant (8 subjects showed improvement in BCVA of 2 lines or more on Snellen charts)
p = 0.45

10. Complications Complications n Lenticule dislocation 1
Primary graft failure
Complications n
Lenticule dislocation 1
Primary graft failure 2
Allograft rejection
Secondary glaucoma 3
Interface scarring
Lenticule folds
Allograft rejection
Interface scarring
Lenticule folds

11. Results Graft survival: DSEK in failed grafts – 60%
Graft survival: DSEK in other indications – 91%

12. Conclusions Endothelial keratoplasty in failed grafts good option
Endothelial cell loss mimics that for other indications
Clinically significant visual improvement
Allograft rejection and primary failure more common
Graft survival significantly lower than for other indications