Visual Outcomes of Repeat Versus Primary Descemet Stripping Automated Endothelial Keratoplasty-A Paired Comparison

Purpose: To compare the results of repeat Descemet stripping automated endothelial keratoplasty (DSAEK) with those of primary DSAEK. Materials and Methods: This retrospective study consisted of all consecutive eyes that underwent one or more repeat DSAEK surgeries after primary DSAEK performed at Villa Serena-Villa Igea Private Hospitals (Forlì, Italy) between January 2005 and June 2015. A paired comparison between the outcomes of primary and the second DSAEK was performed. Main outcome measures included best recorded best spectacle-corrected visual acuity (BSCVA), postoperative endothelial cell loss (ECL), and refractive error. Results: Of 1413 procedures, 51 eyes were included in the final analysis. Indications for primary DSAEK included pseudophakic bullous keratopathy (n = 21), Fuchs endothelial dystrophy (n = 20), failed penetrating keratoplasty (n = 9), and trauma (n = 1). Indications for repeat DSAEK were slowly progressive ECL (n = 35), endothelial rejection (n = 15), and host-graft interface abnormalities (n = 1). Preoperative BSCVA (logarithm of the minimum angle of resolution 1.23 6 0.8 vs. 1.38 6 0.6, P = 0.29) and best postoperative BSCVA (logarithm of the minimum angle of resolution 0.32 6 0.44 vs. 0.34 6 0.49, P = 0.70) did not differ significantly between the 2 groups. ECLs for primary and repeat DSAEK at 1 (46% 6 16% vs. 40% 6 18%, P = 0.22) and 2 years (50% 6 18% vs. 44% 6 2%, P = 0.33) were also similar. The mean postoperative spherical equivalent did not differ significantly between the 2 groups (20.01 6 1.9 vs. 20.5 6 1.6, P = 0.08) nor did the absolute astigmatic error (1.6 6 1 vs. 1.8 6 1.2, respectively, P = 0.17). Conclusions: After the failure of a primary DSAEK graft, a subsequent DSAEK can yield visual outcomes and ECL rates that are comparable with those of primary DSAEK.