title: Descemet stripping and automated endothelial keratoplasty (DSAEK) in eyes with failed penetrating keratoplasty.
abstract: OBJECTIVE
  To report our results of using Descemet stripping and automated endothelial keratoplasty (DSAEK) in eyes with failed penetrating keratoplasty (PK).
  
  
  METHODS
  An institutional review board-approved, prospective, surgical case series of 7 eyes of 7 consecutive patients undergoing DSAEK for graft failure after 1 or more PKs at 1 academic eye center.
  
  
  RESULTS
  The mean follow-up period was 13.3 months (range, 9-18 months). One eye suffered recurrent donor graft dislocation and elected to undergo repeat PK instead of repeat DSAEK. Of the remaining 6 patients, the average preoperative visual acuity (VA) was 20/851 compared with a best-corrected visual acuity (BCVA) of 20/65 postoperatively (P = 0.008). After DSAEK, 6 (100%) eyes showed improved BCVA, and 4 of 6 eyes (67%) achieved a BCVA of 20/40 or better. All 6 grafts remained clear at the last follow-up visit. Two eyes showed graft dislocation on the first postoperative day and underwent repositioning of the lenticule with good results. Two other eyes were diagnosed with primary iatrogenic graft failure within 1 week of DSAEK and underwent repeat DSAEK with new donor tissue with good results. One eye experienced acute graft rejection that was successfully treated with topical steroids.
  
  
  CONCLUSIONS
  This pilot series of DSAEK in eyes with graft failure from previous PK shows favorable VA and graft clarity outcomes. The complications observed were similar to those observed for DSAEK for Fuchs dystrophy and pseudophakic bullous keratopathy and include graft dislocation, iatrogenic graft failure, and homograft rejection.
authors.affiliation: The Eye Institute, Medical College of Wisconsin, Milwaukee, WI 53226, USA.
authors.forename: Douglas J
authors.initials: DJ
authors.lastname: Covert
authors.forename: Steven B
authors.initials: SB
authors.lastname: Koenig
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016039:Corneal Transplantation / Q000379:methods*; D003886:Descemet Membrane / Q000601:surgery*; D004728:Endothelium, Corneal / Q000637:transplantation*; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection / Q000601:surgery; D006801:Humans; D015948:Keratoplasty, Penetrating; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D011446:Prospective Studies; D012086:Reoperation; D017211:Treatment Failure; D016896:Treatment Outcome; D014792:Visual Acuity