title: [DSAEK after failed penetrating keratoplasty].
abstract: OBJECTIVE
  To report the anatomic and functional outcomes of Descemet's stripping automated endothelial keratoplasty (DSAEK) in 32 eyes after failed penetrating keratoplasty (PK).
  
  
  METHODS
  This retrospective, single-center observational study was performed on 32 eyes of 26 patients with failed PK grafts who underwent DSAEK between June 2009 and June 2013 at Clermont-Ferrand University Medical Center. Primary outcomes measured were: graft survival rates, functional improvement (visual acuity), and complications.
  
  
  RESULTS
  Mean follow-up was 16.45 months [6-36]. Graft survival at 12 months was 76.1 % [68.1-82.3]. PK grafts cleared in 75 % of cases. Eight primary DSAEKs detached and/or decentered early (prior to day 8, average 6.22 days): 3 underwent repeat DSAEK with a new graft, and 3 underwent conversion to PK. Results were available for 26 patients at 6 months. Mean preoperative best-corrected visual acuity (BCVA) in logMAR increased from 1.48 (counting fingers at 2 meters) to 0.996 logMAR (1/10) at 6 months. BCVA improved in 17 patients (68 %). BCVA improved an average of 5.2 lines (P=0.0006). Eight patients had a large number of comorbid conditions that limited final visual acuity.
  
  
  CONCLUSIONS
  Anatomic outcomes are similar to other studies. Final average BCVA was limited by severe comorbid conditions and performance of DSAEK solely for comfort. Many surgical strategies have been described to decrease graft dislocation and primary graft failure. Adapting graft trephine diameter to the host cornea as measured by AS-OCT, using a nomogram based on posterior corneal curvature obtained on AS-OCT, may be an interesting approach.
  
  
  CONCLUSIONS
  DSAEK allows for quick visual recovery by preserving the anterior corneal curvature. It is an essential option for restoring corneal clarity in PK failure due to endothelial decompensation. A longer follow-up would allow a comparison of graft survival for the two techniques in this context.
authors.affiliation: RMND-M2O Pole, Ophthalmology department, Clermont-Ferrand University Hospital, 58, rue Montalembert, 63000 Clermont-Ferrand, France. Electronic address: zitte.karen@hotmail.fr.
authors.forename: K
authors.initials: K
authors.lastname: Zitte
authors.affiliation: RMND-M2O Pole, Ophthalmology department, Clermont-Ferrand University Hospital, 58, rue Montalembert, 63000 Clermont-Ferrand, France; EA 7281 R2D2, Biochemistry Laboratory, Medicine Faculty, Auvergne University, 63000 Clermont-Ferrand, France.
authors.forename: N
authors.initials: N
authors.lastname: Bonnin
authors.affiliation: Biology Pole, Pathology department, Clermont-Ferrand University Hospital, 63000 Clermont-Ferrand, France.
authors.forename: J-L
authors.initials: JL
authors.lastname: Kémény
authors.affiliation: RMND-M2O Pole, Ophthalmology department, Clermont-Ferrand University Hospital, 58, rue Montalembert, 63000 Clermont-Ferrand, France.
authors.forename: F
authors.initials: F
authors.lastname: Bacin
authors.affiliation: Délégation à la recherche clinique et à l'innovation, Clermont-Ferrand University Hospital, 63000 Clermont-Ferrand, France.
authors.forename: A
authors.initials: A
authors.lastname: Mulliez
authors.affiliation: RMND-M2O Pole, Ophthalmology department, Clermont-Ferrand University Hospital, 58, rue Montalembert, 63000 Clermont-Ferrand, France; EA 7281 R2D2, Biochemistry Laboratory, Medicine Faculty, Auvergne University, 63000 Clermont-Ferrand, France.
authors.forename: F
authors.initials: F
authors.lastname: Chiambaretta
mesh_terms: D000287:Administration, Topical; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001623:Betamethasone / Q000008:administration & dosage / Q000627:therapeutic use; D002386:Cataract / Q000453:epidemiology; D002387:Cataract Extraction; D003316:Corneal Diseases / Q000601:surgery; D057111:Descemet Stripping Endothelial Keratoplasty; D019573:Epithelium, Corneal / Q000473:pathology; D005260:Female; D005500:Follow-Up Studies; D006085:Graft Survival; D006801:Humans; D007213:Indomethacin / Q000008:administration & dosage / Q000627:therapeutic use; D056965:Injections, Intraocular; D015948:Keratoplasty, Penetrating; D008297:Male; D008875:Middle Aged; D011182:Postoperative Care; D019591:Pseudophakia / Q000453:epidemiology; D020127:Recovery of Function; D012086:Reoperation; D012189:Retrospective Studies; D014031:Tobramycin / Q000008:administration & dosage / Q000627:therapeutic use; D016896:Treatment Outcome; D014792:Visual Acuity
chemical_list: D001623:Betamethasone; D014031:Tobramycin; D007213:Indomethacin
keywords: Descemet's stripping automated endothelial keratoplasty (DSAEK); Detachment of the graft; Décollement du greffon; Failed transfixing keratoplasty; Graft endothelial; Greffe endothéliale; Échec de kératoplastie transfixiante