Secondary DMEK for poor visual outcome after DSEK: donor posterior stroma may limit visual acuity in endothelial keratoplasty

Cornea. 2010 Nov;29(11):1278-83. doi: 10.1097/ICO.0b013e3181cda01a.


Purpose: To describe the clinical outcome of a secondary Descemet membrane endothelial keratoplasty (DMEK) to manage poor visual outcome after Descemet stripping endothelial keratoplasty (DSEK).

Methods: Three eyes of 3 patients that underwent DSEK for Fuchs endothelial dystrophy showed fluctuating and/or poor visual outcome ranging from 20/80 (0.25) to 20/40 (0.5). In a secondary procedure, 16-22 months after the initial DSEK, the DSEK graft was removed and replaced by a DMEK graft. The clinical outcome was evaluated by comparing the pre- to postoperative best-corrected visual acuity (BCVA), Pentacam imaging, and biomicroscopy.

Results: All secondary DMEK procedures were uneventful. Three months after secondary DMEK, all eyes had a BCVA of 20/25 (0.8) or better. Pentacam analysis showed a virtually stable anterior corneal curvature in all cases, but among cases, the transplant exchange induced variable refractive change at the posterior corneal surface.

Conclusion: To manage DSEK cases with poor visual outcome, secondary DMEK may be a feasible procedure potentially resulting in full visual rehabilitation, as in primary DMEK. The presence of donor posterior stroma in DSEK, but not in DMEK grafts, may be a major factor in limiting the final BCVA in endothelial keratoplasty.

Publication types

  • Case Reports
  • Comparative Study

MeSH terms

  • Adult
  • Corneal Stroma / physiopathology*
  • Descemet Stripping Endothelial Keratoplasty / adverse effects*
  • Eyeglasses
  • Feasibility Studies
  • Female
  • Fuchs' Endothelial Dystrophy / surgery*
  • Humans
  • Male
  • Middle Aged
  • Postoperative Period
  • Reoperation
  • Tissue Donors*
  • Treatment Outcome
  • Vision Disorders / etiology*
  • Vision Disorders / physiopathology*
  • Vision Disorders / surgery
  • Visual Acuity*