A Multicenter Study Evaluating the Risk Factors and Outcomes of Repeat Descemet Stripping Endothelial Keratoplasty (original) (raw)

Endothelial keratoplasty (EK) describes a group of surgical procedures for managing corneal endothelial dysfunction. The most common is Descemet's stripping endothelial keratoplasty (DSEK). The procedure may be repeated in the event of a failed DSEK from several causes. There have been several reports examining various combinations of repeat keratoplasty techniques for failed grafts (full and partialthickness). Since the number of repeat DSEK cases is typically low at any single center, our aim was to collaborate with the Eversight Eye Bank to establish a multicenter study to evaluate a large number of repeat DSEK cases. The goal of our study is to report the risk factors and outcomes of the repeat DSEK procedures from multiple sites/surgeons to provide a more realistic assessment of the results. Methods: We performed an IRB-approved, multicenter, retrospective chart review of patients who had a repeat DSEK following a prior failed DSEK. Eversight Eye Bank provided detailed donor information including age, sex, pre-and post-cut corneal thickness, endothelial cell densities, graft thickness and death to preservation time. Five different Midwest academic centers and two private practice centers participated in the study. Information extracted from the participant charts included: recipient demographics, pre-op and post-op visual acuities, initial and repeat DSEK indications, central corneal thickness, number of glaucoma drops pre-and postrepeat DSEK, post-op endothelial cell counts, central corneal thickness and comorbid ocular and systemic diseases. Results: A total of 120 eyes from 120 patients who underwent repeat DSEK were identified among the study sites. The average age was 70 ± 12 years with a female-to-4 male ratio of 1.45:1. The average time from initial to repeat DSEK for all patients was approximately 1.9 years and significantly differed per indication. The most common indication for initial DSEK was Fuch's endothelial dystrophy (31%, N=38). The most common indication for repeat DSEK was late endothelial graft failure without rejection (52%, N=63). Average pre-and 12 month post-repeat DSEK best corrected distance visual acuities (BCDVA) were 20/693 and 20/89, respectively. The mean repeat donor graft thickness was 153 ± 43 microns. The mean initial and repeat donor endothelial cell counts were 2767 ± 264 cells/mm 2 and 2744 ± 272 cells/mm 2 , respectively. Initial and repeat graft re-bubble rates were 34% (N = 40) and 15% (N = 18). The presence of glaucoma, prior glaucoma surgery or a history of PKP did not significantly affect the visual outcomes; however, there was a trend towards better visual outcomes in patients with an absence of glaucoma, anti-hypertensive eye drops and glaucoma surgery. Patients with higher pre-operative intraocular pressures prior to repeat DSEK had statistically significant improvements in postoperative visual acuities. Conclusion: Our report represents the largest multi-center study describing risk factors, indications and outcomes of repeat DSEK surgery. Repeating DSEK provides a good option for improving vision following failed or decompensated initial DSEK surgery. The results of the study may provide valuable information for surgeons considering a repeat DSEK procedure.