title: Back-up procedure for graft failure in Descemet membrane endothelial keratoplasty (DMEK).
abstract: OBJECTIVE
  To evaluate the efficacy of a secondary Descemet stripping endothelial keratoplasty (DSEK) as a back-up procedure for managing graft failure after primary Descemet membrane endothelial keratoplasty (DMEK).
  
  
  METHODS
  Non-randomised prospective clinical study.
  
  
  METHODS
  A first group of 50 cases with Fuchs endothelial dystrophy underwent DMEK. Two to five weeks after the DMEK, 10 cases showed no corneal clearance, so a secondary DSEK was performed. To evaluate the eyes of these 10 cases, best corrected visual acuity (BCVA) and endothelial cell density at 6 and 12 months were used as outcome parameters.
  
  
  RESULTS
  At 6 months after secondary DSEK, 87% of the cases had a BCVA of > or = 20/40 (> or = 0.5) and one eye reached 20/25 (> or = 0.8). Donor DSEK grafts endothelial cell densities averaged 2617+/-152 cells/mm2 before surgery, 1510+/-799 cells/mm2 at 6 months and 1602+/-892 cells/mm2 at 12 months after surgery.
  
  
  CONCLUSIONS
  In the event of a DMEK graft failure, a secondary DSEK may be an effective back-up procedure, as it may give a clinical outcome similar to that after a primary DSEK. Particularly during the surgeon's learning curve, patient information may be provided not only on visual outcomes after DMEK, but also after DSEK.
  
  
  BACKGROUND
  NCT00521898.
authors.affiliation: Netherlands Institute for Innovative Ocular Surgery, Rotterdam, The Netherlands.
authors.forename: Isabel
authors.initials: I
authors.lastname: Dapena
authors.forename: Lisanne
authors.initials: L
authors.lastname: Ham
authors.forename: Chantal
authors.initials: C
authors.lastname: van Luijk
authors.forename: Jacqueline
authors.initials: J
authors.lastname: van der Wees
authors.forename: Gerrit R J
authors.initials: GR
authors.lastname: Melles
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D057111:Descemet Stripping Endothelial Keratoplasty / Q000379:methods*; D005260:Female; D005642:Fuchs' Endothelial Dystrophy / Q000503:physiopathology / Q000601:surgery*; D006084:Graft Rejection / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012086:Reoperation / Q000379:methods; D016896:Treatment Outcome; D014792:Visual Acuity / Q000502:physiology