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Purpose: To compare the clinical outcomes of repeat penetrating keratoplasty (PK), Descemet stripping automated endothelial keratoplasty (‘DSAEK-on-PK’) or Descemet membrane endothelial keratoplasty (‘DMEK-on-PK’) for the management of endothelial failure of previous penetrating keratoplastyDesign: Retrospective, interventional consecutive case series. Participants: 104 consecutive eyes of 100 patients requiring a second keratoplasty for endothelial failure of their primary penetrating keratoplasty performed between September 2016 and December 2020Intervention: Repeat keratoplastyMain Outcome Measures: Primary failure rate, 12 and 24 month survival, visual acuity at 12 and 24 months, rebubbling rate and complication profile.Results: Repeat PK was performed in 61/104 eyes (58.7%), DSAEK-on-PK was performed in 21/104 eyes (20.2%) and DMEK-on-PK was performed in 22/104 eyes (21.2%). 6.6% of repeat PKs failed in the first 12 months compared to 19% of DSAEK and 36.4% of DMEK. Chances of 2 year survival were 79.4% for repeat PK, 69.4% for DSAEK and 58.7% for DMEK. Visual acuity at one year was logMAR 0.53±0.51 in the redo PK group, 0.25±0.17 for DSAEK and 0.30±0.38 for DMEK. 24 month outcomes were 0.34± 0.28, 0.08 ± 0.16, and 0.36 ± 0.36 respectively.Conclusions: DMEK-on-PK and DSAEK-on-PK are known to have greater primary failure rates than redo PK but have faster rehabilitation times. DMEK-on-PK may offer the best clinical outcome when successful but also has the greatest primary failure rate. |
