title: Visual Recovery and Endothelial Cell Survival After Descemet Stripping Automated Endothelial Keratoplasty for Failed Penetrating Keratoplasty Grafts—A Cohort Study.
abstract: OBJECTIVE
  To assess visual recovery and donor cell survival after Descemet stripping automated endothelial keratoplasty (DSAEK) for the repair of failed penetrating keratoplasty (PK) grafts.
  
  
  METHODS
  Best spectacle-corrected Snellen visual acuity results after DSAEK were compared with best-ever documented visual acuity (BDVA) results obtained with the previous PK graft in a prospective cohort study. Donor cell survival after DSAEK for PK repair was compared with cell survival after DSAEK for Fuchs endothelial dystrophy and pseudophakic bullous keratopathy. Differences in the logMAR best spectacle-corrected Snellen visual acuity and endothelial cell loss rates were calculated.
  
  
  RESULTS
  Twenty-eight eyes with DSAEK for PK repair were identified, 21 of which lacked vision-limiting comorbidities. The mean follow-up was 18.4 ± 10.6 months. At 3 months postoperatively, 10/21 eyes (48%) regained their BDVA. By 24 months, only 14% remained with 0.2 logMAR below their BDVA. Endothelial cell counts decreased significantly faster in patients with DSAEK for failed PK (P = 0.024) or pseudophakic bullous keratopathy (P = 0.018) than in patients with DSAEK for Fuchs endothelial dystrophy.
  
  
  CONCLUSIONS
  DSAEK for the restoration of failed PK grafts promotes rapid visual recovery within the visual limits of the previous PK graft. Increased endothelial cell loss is noted relative to other DSAEK indications, which may result in earlier endothelial graft failure in renovated PK.
authors.affiliation: *Department of Ophthalmology, Cantonal Hospital of Lucerne, Lucerne, Switzerland; and †Medignition Inc, Research Consultants, Zürich, Switzerland.
authors.forename: Janine N
authors.initials: JN
authors.lastname: Tarantino-Scherrer
authors.forename: Claude
authors.initials: C
authors.lastname: Kaufmann
authors.forename: Frank
authors.initials: F
authors.lastname: Bochmann
authors.forename: Lucas M
authors.initials: LM
authors.lastname: Bachmann
authors.forename: Michael A
authors.initials: MA
authors.lastname: Thiel
mesh_terms: D000368:Aged; D000505:Alopecia / Q000503:physiopathology / Q000601:surgery*; D002470:Cell Survival / Q000502:physiology; D057111:Descemet Stripping Endothelial Keratoplasty; D004392:Dwarfism / Q000503:physiopathology / Q000601:surgery*; D004728:Endothelium, Corneal / Q000166:cytology*; D004820:Epidermolysis Bullosa / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D005642:Fuchs' Endothelial Dystrophy / Q000503:physiopathology / Q000601:surgery*; D040181:Genetic Diseases, X-Linked / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D008607:Intellectual Disability / Q000503:physiopathology / Q000601:surgery*; D015948:Keratoplasty, Penetrating; D008297:Male; D008831:Microcephaly / Q000503:physiopathology / Q000601:surgery*; D008875:Middle Aged; D010859:Pigmentation Disorders / Q000503:physiopathology / Q000601:surgery*; D011446:Prospective Studies; D020127:Recovery of Function / Q000502:physiology*; D014019:Tissue Donors; D017211:Treatment Failure; D014792:Visual Acuity / Q000502:physiology*