title: Outcomes of repeat endothelial keratoplasty in patients with failed deep lamellar endothelial keratoplasty.
abstract: OBJECTIVE
  To report the outcomes of repeat endothelial keratoplasty (EK) in patients with previous failed deep lamellar endothelial keratoplasty (DLEK).
  
  
  METHODS
  This retrospective interventional case series involved the review of clinical records of patients with failed DLEK surgery who underwent repeat EK surgery.
  
  
  RESULTS
  Ten eyes of 9 patients (2 men and 7 women) were included. The mean age at initial DLEK surgery was 71.2 ± 8.0 years (range, 59-80 years), and the duration to repeat EK was 47 ± 14.3 months (range, 16-63 months). Removal of the failed DLEK donor disc was performed in 7 eyes (70%); in 3 eyes (30%), repeat EK was performed without removal of the failed donor disc. The mean follow-up after repeat EK surgery was 21.7 months (range, 3-44 months). Improvements in corneal clarity and visual acuity were obtained in all eyes. Mean preoperative logarithm of the minimum angle of resolution (logMAR) best-corrected visual acuity (BCVA) was 1.46 (20/577; range, 20/100 to counting fingers) and improved to 0.64 (20/87; range, 20/30 to 20/300) at the final follow-up (P = 0.03). Four eyes had limited BCVA secondary to ocular comorbidites, including age-related macular degeneration, cystoid macular edema, and advanced glaucomatous optic neuropathy. No significant postoperative complications were noted after repeat EK surgeries.
  
  
  CONCLUSIONS
  Repeat EK in patients with late DLEK failure is effective in improving corneal clarity and is a viable alternative to penetrating keratoplasty (PK). Surgery may be performed with or without removal of the failed donor disc. Visual outcomes may be limited by the existence of ocular comorbidities.
authors.affiliation: Department of Ophthalmology, Toronto Western Hospital, University of Toronto, Toronto, Canada. peterkim76@gmail.com
authors.forename: Peter
authors.initials: P
authors.lastname: Kim
authors.forename: Elliott
authors.initials: E
authors.lastname: Brodbaker
authors.forename: Alejandro
authors.initials: A
authors.lastname: Lichtinger
authors.forename: Sonia N
authors.initials: SN
authors.lastname: Yeung
authors.forename: Irit
authors.initials: I
authors.lastname: Bahar
authors.forename: Alfonso
authors.initials: A
authors.lastname: Iovieno
authors.forename: Maoz D
authors.initials: MD
authors.lastname: Amiran
authors.forename: David S
authors.initials: DS
authors.lastname: Rootman
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D057111:Descemet Stripping Endothelial Keratoplasty; D004728:Endothelium, Corneal / Q000637:transplantation*; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection / Q000209:etiology / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012086:Reoperation; D012189:Retrospective Studies; D016896:Treatment Outcome; D014792:Visual Acuity / Q000502:physiology