title: Secondary DMEK for poor visual outcome after DSEK: donor posterior stroma may limit visual acuity in endothelial keratoplasty.
abstract: OBJECTIVE
  To describe the clinical outcome of a secondary Descemet membrane endothelial keratoplasty (DMEK) to manage poor visual outcome after Descemet stripping endothelial keratoplasty (DSEK).
  
  
  METHODS
  Three eyes of 3 patients that underwent DSEK for Fuchs endothelial dystrophy showed fluctuating and/or poor visual outcome ranging from 20/80 (0.25) to 20/40 (0.5). In a secondary procedure, 16-22 months after the initial DSEK, the DSEK graft was removed and replaced by a DMEK graft. The clinical outcome was evaluated by comparing the pre- to postoperative best-corrected visual acuity (BCVA), Pentacam imaging, and biomicroscopy.
  
  
  RESULTS
  All secondary DMEK procedures were uneventful. Three months after secondary DMEK, all eyes had a BCVA of 20/25 (0.8) or better. Pentacam analysis showed a virtually stable anterior corneal curvature in all cases, but among cases, the transplant exchange induced variable refractive change at the posterior corneal surface.
  
  
  CONCLUSIONS
  To manage DSEK cases with poor visual outcome, secondary DMEK may be a feasible procedure potentially resulting in full visual rehabilitation, as in primary DMEK. The presence of donor posterior stroma in DSEK, but not in DMEK grafts, may be a major factor in limiting the final BCVA in endothelial keratoplasty.
authors.affiliation: Netherlands Institute for Innovative Ocular Surgery, Rotterdam, The Netherlands.
authors.forename: Lisanne
authors.initials: L
authors.lastname: Ham
authors.forename: Isabel
authors.initials: I
authors.lastname: Dapena
authors.forename: Jacqueline
authors.initials: J
authors.lastname: van der Wees
authors.forename: Gerrit R J
authors.initials: GR
authors.lastname: Melles
mesh_terms: D000328:Adult; D003319:Corneal Stroma / Q000503:physiopathology*; D057111:Descemet Stripping Endothelial Keratoplasty / Q000009:adverse effects*; D005139:Eyeglasses; D005240:Feasibility Studies; D005260:Female; D005642:Fuchs' Endothelial Dystrophy / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011184:Postoperative Period; D012086:Reoperation; D014019:Tissue Donors; D016896:Treatment Outcome; D014786:Vision Disorders / Q000209:etiology* / Q000503:physiopathology* / Q000601:surgery; D014792:Visual Acuity