Endothelial keratoplasty without Descemet's stripping in eyes with previous penetrating corneal transplants.

Aims: To evaluate techniques, outcomes and complications of endothelial keratoplasty (EK) without Descemet's stripping in eyes with previous penetrating keratoplasty (PK).

Methods: A retrospective, consecutive analysis of patients who underwent EK in eyes with previous PK.

Results: 33 eyes of 31 consecutive patients underwent EK without Descemet's stripping in eyes with previous PK. All 33 eyes were followed for an average of 14.2 ± 4.4 months. The reason for EK was either graft rejection (n=9) or endothelial failure (n=24). 32/33 (97.0%) eyes remained clear at the last follow-up visit. Visual acuity improved in 28/33 (84.8%) patients with 19/28 (67.9%) of these patients having more than three lines of visual acuity improvement. The average postoperative vision in this group was 20/60 (range 20/25-20/100). Pre-cut donor tissue was used for all cases with an average thickness of 127 μm. Endothelial cell density declined by 35% at 3 months and was stable at 1 year. 2/33 (6%) eyes had graft dislocations. One eye was successfully treated by a re-bubble. The other case failed EK revision and required a repeat PK. No patients developed EK or PK graft failure/rejection.

Conclusion: EK without Descemet's membrane stripping in eyes with previous PK graft failure/rejection is a valuable alternative to a repeat full thickness PK.