title: Repeat Descemet membrane endothelial keratoplasty after complicated primary Descemet membrane endothelial keratoplasty.
abstract: OBJECTIVE
  To describe the clinical outcome and complications of repeat Descemet membrane endothelial keratoplasty (re-DMEK).
  
  
  METHODS
  Retrospective case series study at a tertiary referral center.
  
  
  METHODS
  From a series of 550 consecutive DMEK surgeries with ≥ 6 months follow-up, 17 eyes underwent re-DMEK for graft detachment after initial DMEK (n = 14) and/or endothelial graft failure (n = 3). The outcomes were compared with an age-matched control group of uncomplicated primary DMEK surgeries.
  
  
  METHODS
  The re-DMEK eyes were evaluated for best-corrected visual acuity (BCVA), densitometry, endothelial cell density (ECD), pachymetry, and intraoperative and postoperative complications.
  
  
  METHODS
  Feasibility and clinical outcome of re-DMEK.
  
  
  RESULTS
  In all eyes, re-DMEK was uneventful. At 12 months, 12 of 14 eyes (86%) achieved a BCVA of ≥ 20/40 (≥ 0.5); 8 of 14 eyes (57%) achieved ≥ 20/25 (≥ 0.8), 3 of 14 eyes (21%) achieved ≥ 20/20 (≥ 1.0), and 1 eye (7%) achieved 20/17 (1.2); 5 eyes were fitted with a contact lens. Average donor ECD decreased from 2580 ± 173 cells/mm(2) before to 1390 ± 466 cells/mm(2) at 6 months after surgery, and pachymetry from 703 ± 126 μm to 515 ± 39 μm, respectively. No difference in densitometry could be detected between re-DMEK and control eyes (P = 0.99). Complications after re-DMEK included primary graft failure (n = 1), secondary graft failure (n = 2), graft detachment requiring rebubbling (n = 1), secondary glaucoma (n = 2), cataract (n = 1), and corneal ulcer (n = 1). One eye received tertiary DMEK.
  
  
  CONCLUSIONS
  In the management of persistent graft detachment and graft failure after primary DMEK, re-DMEK proved a feasible procedure. Acceptable BCVA may be achieved, albeit lower than after DMEK in virgin eyes, and some cases may benefit from contact lens fitting. Complications after re-DMEK may be better anticipated than after primary DMEK because graft detachment and graft failure tended to recur, suggesting that intrinsic properties of the host eye play a role in graft adherence and graft failure.
authors.affiliation: Netherlands Institute for Innovative Ocular Surgery, Rotterdam, The Netherlands; Melles Cornea Clinic, Rotterdam, The Netherlands; Amnitrans EyeBank, Rotterdam, The Netherlands.
authors.forename: Lamis
authors.initials: L
authors.lastname: Baydoun
authors.affiliation: Netherlands Institute for Innovative Ocular Surgery, Rotterdam, The Netherlands; Melles Cornea Clinic, Rotterdam, The Netherlands.
authors.forename: Korine
authors.initials: K
authors.lastname: van Dijk
authors.affiliation: Netherlands Institute for Innovative Ocular Surgery, Rotterdam, The Netherlands; Melles Cornea Clinic, Rotterdam, The Netherlands.
authors.forename: Isabel
authors.initials: I
authors.lastname: Dapena
authors.affiliation: Netherlands Institute for Innovative Ocular Surgery, Rotterdam, The Netherlands; Melles Cornea Clinic, Rotterdam, The Netherlands; Calderdale and Huddersfield NHS Trust, Huddersfield, West Yorkshire, UK.
authors.forename: Fayyaz U
authors.initials: FU
authors.lastname: Musa
authors.affiliation: Netherlands Institute for Innovative Ocular Surgery, Rotterdam, The Netherlands; Melles Cornea Clinic, Rotterdam, The Netherlands.
authors.forename: Vasilis S
authors.initials: VS
authors.lastname: Liarakos
authors.affiliation: Netherlands Institute for Innovative Ocular Surgery, Rotterdam, The Netherlands; Melles Cornea Clinic, Rotterdam, The Netherlands; Amnitrans EyeBank, Rotterdam, The Netherlands.
authors.forename: Lisanne
authors.initials: L
authors.lastname: Ham
authors.affiliation: Netherlands Institute for Innovative Ocular Surgery, Rotterdam, The Netherlands; Melles Cornea Clinic, Rotterdam, The Netherlands; Amnitrans EyeBank, Rotterdam, The Netherlands. Electronic address: research@niios.com.
authors.forename: Gerrit R J
authors.initials: GR
authors.lastname: Melles
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002452:Cell Count; D003316:Corneal Diseases / Q000601:surgery*; D063171:Corneal Pachymetry; D057111:Descemet Stripping Endothelial Keratoplasty / Q000009:adverse effects* / Q000379:methods*; D004728:Endothelium, Corneal / Q000473:pathology; D005240:Feasibility Studies; D005260:Female; D006084:Graft Rejection / Q000209:etiology; D006801:Humans; D007431:Intraoperative Complications; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D012086:Reoperation; D012189:Retrospective Studies; D014019:Tissue Donors; D014792:Visual Acuity / Q000502:physiology