@article{3029129,
    title = "Secondary DMEK following failed primary DMEK",
    author = "Droutsas, Konstantinos and Alexopoulos, Palaiologos and Giachos, Ioannis and and Giallouros, Eleftherios and Sekundo, Walter and Lazaridis, Apostolos",
    journal = "International Ophthalmology",
    year = "2021",
    volume = "41",
    number = "10",
    pages = "3287-3293",
    publisher = "Springer-Verlag",
    issn = "0165-5701",
    doi = "10.1007/s10792-021-01890-2",
    keywords = "DMEK; DSAEK; Penetrating keratoplasty; Endothelial cell density; Graft
survival",
    abstract = "Purpose To report the outcomes of secondary Descemet Membrane
Endothelial Keratoplasty (DMEK) performed for failed primary DMEK.
Methods The medical records of all patients undergoing secondary DMEK
due to failure of primary DMEK were reviewed. Reasons for failure were
sought and best-corrected visual acuity (BCVA), endothelial cell density
(ECD) and complications of secondary DMEK were evaluated. Results A
total of 10 cases undergoing secondary DMEK following failed primary
DMEK were identified. Presumed reasons for failure included donor ECD <=
2300 cells/mm(2) (n = 4), difficulty during graft preparation (n = 2),
graft detachment (n = 2), acute angle closure due to retroiridal air
dislocation (n = 1), inverse graft positioning (n = 1) and
phacoemulsification (n = 1). Eyes with low visual potential were not
excluded from the study group. We should note that one patient (case
no7) had both low ECD and graft detachment as reasons for failure and as
a result he is counted twice. Median BCVA (decimal fraction) increased
from 0.1 (range, 0.01; 0.3) to 0.5 (0.05; 1.0) at one month and remained
stable thereafter. A BCVA of 0.5 or higher was achieved in 7 cases at
the final follow-up. Mean ECD fell from 2628 +/- 284 cells/mm(2) to 1391
+/- 252cells/mm(2) at 6 months (47% reduction) and 959 +/-
225cells/mm(2) at 24 months (64% reduction) (P <= 0.028). Complications
included the incomplete removal of the primary graft and mild iris
bleeding, decompensation of a preexisting primary open-angle glaucoma
and retroiridal air dislocation. Conclusions Apart from low donor ECD,
surgical challenges, i.e., difficulty with graft preparation, inverse
graft positioning, and retroiridal air dislocation, were main reasons
for failure of primary DMEK. Secondary DMEK showed a good safety profile
and reasonable visual outcomes."
}