title: Descemet Membrane Endothelial Keratoplasty as a Secondary Approach After Failure of Penetrating Keratoplasty.
abstract: OBJECTIVE
  To investigate visual outcome and postoperative complications in patients undergoing Descemet membrane endothelial keratoplasty with graft failure after penetrating keratoplasty.
  
  
  METHODS
  A retrospective analysis was performed with 5 patients who underwent Descemet membrane endothelial keratoplasty after failed penetrating keratoplasty. Intraoperative and postoperative complications were recorded. Visual acuity, rehabilitation phase, refraction stability, central corneal thickness, endothelial cell count, possible immunologic reactions, and optical coherence tomography of the anterior eye segment were evaluated. A subjective questionnaire was used to evaluate patient satisfaction.
  
  
  RESULTS
  There were no intraoperative complications. All patients had graft detachment, which made air injection necessary. In all cases, visual acuity significantly increased (medium visual acuity [logarithm of the minimum angle of resolution]: 0.68 ± 0.31 logarithm of the minimum angle of resolution after 4 weeks and 0.35 ± 0.37 after 6 months; P = .043), refraction was stable, corneal thickness was reduced (average, 514 ± 11 μm), and endothelial cell count was reduced (average, 1398 ± 510 cells/mm(2)) after 6 months, which corresponds with a medium loss 40%. In the questionnaire, visual outcome, estimated time for recovery, and rehabilitation and patient satisfaction were better after Descemet membrane endothelial keratoplasty than penetrating keratoplasty. No postoperative elevation of pressure, development of pupillary block, or graft rejection, and no peripheral anterior synechiae or other abnormalities were observed with optical coherence tomography during the first 6 postoperative months.
  
  
  CONCLUSIONS
  Descemet membrane endothelial keratoplasty is a suitable technique for the treatment of graft failure after penetrating keratoplasty and helped our patients rapidly achieve good visual acuity, with reduction of postoperative complications, but the visual outcome might be limited.
authors: Klinik für Augenheilkunde, Charité Universitätsmedizin Berlin, Campus Virchow-Klinikum Berlin, Germany.
authors: Enken
authors: E
authors: Gundlach
authors: Anna-Karina B
authors: AK
authors: Maier
authors: Aline Isabel
authors: AI
authors: Riechardt
authors: Tobias
authors: T
authors: Brockmann
authors: Eckart
authors: E
authors: Bertelmann
authors: Antonia
authors: A
authors: Joussen
authors: Necip
authors: N
authors: Torun
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003315:Cornea / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D003316:Corneal Diseases / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D057111:Descemet Stripping Endothelial Keratoplasty / Q000009:adverse effects; D005260:Female; D006801:Humans; D015948:Keratoplasty, Penetrating / Q000009:adverse effects*; D008297:Male; D017060:Patient Satisfaction; D011183:Postoperative Complications / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D020127:Recovery of Function; D012086:Reoperation; D012189:Retrospective Studies; D011795:Surveys and Questionnaires; D013997:Time Factors; D041623:Tomography, Optical Coherence; D017211:Treatment Failure; D014792:Visual Acuity