Identifying causes for poor visual outcome after DSEK/DSAEK following secondary DMEK in the same eye

摘要: . Purpose:  To identify causes of reduced visual acuity after Descemet stripping (automated) endothelial keratoplasty (DSEK/DSAEK) and to determine whether such eyes can be successfully ‘repaired’ with a secondary membrane (DMEK). Methods:  Twelve 12 patients, who underwent DMEK manage poor outcome initial DSEK/DSAEK, were evaluated biomicroscopy, Pentacam imaging, specular confocal microscopy, before at 1, 3 6 months DMEK. Results:  Four optical quality the transplanted host cornea could identified in DSEK/DSAEK: five (42%) showed large host-Descemet remnants within axis during surgery; six (50%) irregular graft thickness; subtle ‘stromal waves’; nine (75%) high reflectivity donor-to-host interface. After replacement, all corneas cleared achieved best corrected ≥20/25 (≥0.8), except for one partial detachment. Pachymetry values decreased from 670 (±112) μm 517 (±57) μm DMEK. Higher-order aberrations (Coma Trefoil) posterior surface tended lower (p = 0.07) grafts than DSEK/DSAEK grafts. Conclusion:  Host-Descemet interface, interface reflectivity, thickness irregularity donor stromal contraction may contribute without causing permanent corneal damage, as most cases, complete recovery by performing