title: Descemet stripping endothelial keratoplasty for a failed penetrating keratoplasty graft in a pseudophakic patient with a toric intraocular lens: a case report.
abstract: BACKGROUND
  To report a patient with penetrating keratoplasty (PKP) graft endothelial failure implanted with toric intraocular lens (IOL) who was treated with Descemet stripping endothelial keratoplasty (DSAEK).
  
  
  METHODS
  A 40 year old male patient implanted with toric intraocular lens for the treatment of post PKP astigmatism, presented for the treatment of graft endothelial failure'. The patient had uncorrected distance visual acuity (UDVA) 20/200 not correcting with manifest refraction. The patient reported excellent visual acuity after cataract surgery and toric IOL implantation. DSAEK was performed in order to minimally affect keratometry and retain correspondence of the anterior cornea astigmatism with the toric IOL astigmatic power. Three months postoperatively the cornea was clear with no edema. UDVA was 20/40 and corrected distance visual acuity was 20/25 with +1.50-1.00 × 20.
  
  
  CONCLUSIONS
  This report describes a unique case of DSAEK for treatment of a failed PKP in a patient previously implanted with a toric IOL. DSAEK was an effective alternative of PKP in this patient for the preservation of the toric IOL's effect.
authors.affiliation: University Hospital of Heraklion, University of Crete, Medical School, 71003, Heraklion, Crete, Greece. kymionis@med.uoc.gr.
authors.forename: George D
authors.initials: GD
authors.lastname: Kymionis
authors.forename: George A
authors.initials: GA
authors.lastname: Kontadakis
mesh_terms: D000328:Adult; D001251:Astigmatism / Q000209:etiology / Q000601:surgery; D057111:Descemet Stripping Endothelial Keratoplasty; D006801:Humans; D015948:Keratoplasty, Penetrating; D019654:Lens Implantation, Intraocular; D007910:Lenses, Intraocular; D008297:Male; D019591:Pseudophakia / Q000150:complications / Q000601:surgery*; D012086:Reoperation; D017211:Treatment Failure