Graft dislocation of Descemet stripping automated endothelial keratoplasty after previous failed penetrating keratoplasty proved comparable to that of primary DSAEK, a study found.

“Our series represents the largest to date, multicenter, retrospective chart review of DSAEK in eyes with prior failed [PK],” the study authors said.

The retrospective study included 97 eyes of 90 patients who underwent DSAEK after previously failed PK. Average patient age was 73 years (range: 47 to 96 years).  Cornea. 2011;30(4):414-418.

Results showed that graft dislocation occurred in 30 eyes (31%); 29 eyes required re-bubbling and one graft reattached spontaneously. Ninety-eight percent of grafts remained attached for the entire follow-up period. Two eyes (2%) required repeat DSAEK after primary graft failure.

Endothelial grafts dislocated in 10 of 15 eyes with glaucoma drainage devices (67%) and 20 of 82 eyes without drainage devices (24%); the difference was statistically significant (P = .009).

The graft dislocation rate was 24% in eyes with grafts larger than the host PK graft, 18% in eyes with grafts equal to the host and 42% in eyes with grafts smaller than the host. Between-group differences were statistically insignificant.

Dislocation occurred in five of 21 eyes (24%) with sutures remaining after PK and in 22 of 76 eyes (29%) from which sutures had been removed.

Except in 13 eyes with visual worse than 20/400 and severe ocular comorbidities, Snellen visual acuity improved an average of four lines, the authors reported.