title: Descemet membrane endothelial keratoplasty as treatment for graft failure after descemet stripping automated endothelial keratoplasty.
abstract: OBJECTIVE
  To investigate the outcome of Descemet membrane endothelial keratoplasty (DMEK) in patients with graft failure after Descemet stripping automated endothelial keratoplasty (DSAEK).
  
  
  METHODS
  Retrospective cohort study.
  
  
  METHODS
  setting: Institutional.
  
  
  METHODS
  Fifteen eyes of 15 patients that underwent DMEK for graft failure with corneal decompensation following DSAEK were analyzed; 15 eyes with primary DMEK for Fuchs corneal dystrophy were included as control group.
  
  
  METHODS
  Best-corrected visual acuity (BCVA), endothelial cell density (ECD), central corneal thickness (CCT), and rebubbling rate.
  
  
  RESULTS
  DMEK surgery was successful in all cases of both groups. Mean BCVA (logMAR) before DMEK was 1.27 ± 0.34 in the DMEK after DSAEK group and 1.0 ± 0.40 in the Primary DMEK group. After DMEK, mean BCVA increased significantly to 0.23 ± 0.21 (P = .012, DMEK after DSAEK group) and 0.29 ± 0.23 (P = .042, Primary DMEK group) after 3 months. There were no significant differences in mean BCVA between both groups at each visit. The rebubbling rate was 13% in the DMEK after DSAEK group and 40% in the Primary DMEK group (P = .1). Mean CCT decreased significantly in both groups 1 month after DMEK (P < .05). Mean ECD and change of ECD did not differ significantly between both groups at each visit (P > .05).
  
  
  CONCLUSIONS
  The results after DMEK as a procedure to treat graft failure after DSAEK were as good as in patients that underwent DMEK as primary intervention to treat advanced Fuchs dystrophy. This indicates that the optical quality can be reestablished by DMEK in patients with failed DSAEK.
authors: Department of Ophthalmology, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany. Electronic address: julia.weller@uk-erlangen.de.
authors: Julia M
authors: JM
authors: Weller
authors: Department of Ophthalmology, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany.
authors: Theofilos
authors: T
authors: Tourtas
authors: Department of Ophthalmology, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany.
authors: Friedrich E
authors: FE
authors: Kruse
authors: Department of Ophthalmology, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany.
authors: Ursula
authors: U
authors: Schlötzer-Schrehardt
authors: Department of Ophthalmology, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany.
authors: Thomas
authors: T
authors: Fuchsluger
authors: Department of Ophthalmology, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany.
authors: Björn O
authors: BO
authors: Bachmann
mesh_terms: D000368:Aged; D002452:Cell Count; D015331:Cohort Studies; D063171:Corneal Pachymetry; D057111:Descemet Stripping Endothelial Keratoplasty / Q000379:methods*; D004728:Endothelium, Corneal / Q000473:pathology / Q000648:ultrastructure; D005260:Female; D005642:Fuchs' Endothelial Dystrophy / Q000601:surgery*; D006084:Graft Rejection / Q000209:etiology / Q000601:surgery*; D006801:Humans; D008297:Male; D046529:Microscopy, Electron, Transmission; D011183:Postoperative Complications; D012189:Retrospective Studies; D014792:Visual Acuity / Q000502:physiology