title: Secondary "thin-DSEK" after long-term graft failure in DLEK: a double transplanted cornea.
abstract: OBJECTIVE
  To describe a case of secondary "thin Descemet stripping endothelial keratoplasty" ("Thin-DSEK"), for borderline decompensation 6 years after an initial deep lamellar endothelial keratoplasty (DLEK).
  
  
  METHODS
  In a 31-year-old man, who initially underwent a DLEK for bullous keratopathy in the presence of a phakic intraocular lens, a secondary Thin-DSEK was performed, while leaving the entire DLEK graft (including the donor Descemet membrane and the endothelium) in situ.
  
  
  RESULTS
  After the initial DLEK, the best-corrected visual acuity (BCVA) improved from 20/200 (0.1) to 20/25 (0.8). Six years later, the transplanted cornea showed intermittent decompensation with a decrease in BCVA again to 20/200 (0.1). After the secondary Thin-DSEK, the BCVA improved again to 20/25 (0.8) at 1 month postoperatively and remained stable thereafter.
  
  
  CONCLUSIONS
  Our case may show that a secondary DSEK may be a simple and effective treatment to manage secondary graft failure after DLEK. Despite the presence of a "double" stromal interface in the visual axis, secondary Thin-DSEK may provide visual rehabilitation similar to that after primary Thin-DSEK.
authors.affiliation: Netherlands Institute for Innovative Ocular Surgery, Rotterdam, The Netherlands.
authors.forename: Martin
authors.initials: M
authors.lastname: Dirisamer
authors.forename: Gulcihan
authors.initials: G
authors.lastname: Acis
authors.forename: Isabel
authors.initials: I
authors.lastname: Dapena
authors.forename: Lisanne
authors.initials: L
authors.lastname: Ham
authors.forename: Frans F H
authors.initials: FF
authors.lastname: Versteeg
authors.forename: Gerrit R J
authors.initials: GR
authors.lastname: Melles
mesh_terms: D000328:Adult; D015715:Corneal Edema / Q000601:surgery; D019781:Corneal Topography; D016039:Corneal Transplantation / Q000009:adverse effects*; D057111:Descemet Stripping Endothelial Keratoplasty; D004728:Endothelium, Corneal / Q000637:transplantation; D006084:Graft Rejection / Q000209:etiology / Q000601:surgery*; D006085:Graft Survival / Q000502:physiology; D006801:Humans; D008297:Male; D054120:Phakic Intraocular Lenses; D012086:Reoperation; D041623:Tomography, Optical Coherence; D014792:Visual Acuity / Q000502:physiology