title: Outcomes of Descemet's stripping endothelial keratoplasty in eyes with failed therapeutic penetrating keratoplasty.
abstract: OBJECTIVE
  To report the results of Descemet's stripping endothelial keratoplasty (DSEK) for failed therapeutic penetrating keratoplasty (PK).
  
  
  METHODS
  Twenty-seven eyes of 27 patients undergoing DSEK for failed therapeutic PK were analysed.
  
  
  RESULTS
  The mean age of the patients was 36 ± 13.9 years (range: 14-70 years). The median size of the therapeutic graft was 10 mm (inter-quartile range; IQR 9.5-11 mm). Descemet's membrane stripping was performed in all eyes. Graft clarity was achieved in 20/27 eyes. Six eyes had primary graft failure, and one had interface keratitis in the early postoperative period. In all eyes with primary graft failure, there was progressive stromal vascularization, which led to haziness in the graft. Late postoperative complications were rejection in four eyes, infection in two eyes, secondary graft failure in one eye and vortex keratopathy in one eye. Graft size was found to be a significant risk factor for graft rejection in this series. At the last follow-up visit, the best-corrected visual acuity was ≥20/40 in 5/27 eyes (18.5%), 20/60-20/40 in 12/27 eyes (44.4%), 20/100-20/60 in 3/27 eyes (1.5%) and ≤20/200 in 7/27 eyes (25.9%).
  
  
  CONCLUSIONS
  Considering the limited success of repeat PK in failed large therapeutic keratoplasty, DSEK is a viable option for visual rehabilitation in these eyes, however; visual acuity may be limited due to sub-epithelial/stromal or interface scarring.
authors: Cornea and Anterior Segment Services, L.V. Prasad Eye Institute, Hyderabad, IndiaProf Brien Holden Eye Research Centre, L.V. Prasad Eye Institute, Hyderabad, India.
authors: Sunita
authors: S
authors: Chaurasia
authors: Somasheila
authors: S
authors: Murthy
authors: Muralidhar
authors: M
authors: Ramappa
authors: Ashik
authors: A
authors: Mohamed
authors: Prashant
authors: P
authors: Garg
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002452:Cell Count; D003316:Corneal Diseases / Q000209:etiology / Q000601:surgery*; D055954:Corneal Endothelial Cell Loss / Q000175:diagnosis; D016510:Corneal Neovascularization / Q000209:etiology / Q000601:surgery; D057111:Descemet Stripping Endothelial Keratoplasty / Q000379:methods*; D004728:Endothelium, Corneal / Q000473:pathology; D005260:Female; D006084:Graft Rejection / Q000209:etiology / Q000601:surgery; D006801:Humans; D015948:Keratoplasty, Penetrating; D008297:Male; D008875:Middle Aged; D012086:Reoperation; D012189:Retrospective Studies; D017211:Treatment Failure; D016896:Treatment Outcome; D014792:Visual Acuity / Q000502:physiology; D055815:Young Adult
keywords: Descemet’s stripping endothelial keratoplasty; penetrating keratoplasty; rejection; therapeutic keratoplasty