Femtosecond Descemet Membrane Endothelial Keratoplasty for Failed Deep Anterior Lamellar Keratoplasty: A Case Series

Purpose: – To suggest a new surgical approach for the treatment of failed deep anterior lamellar keratoplasty (DALK) because of posterior opacities or persistent Descemet membrane (DM) detachment and to report the outcome of femtosecond intralase-enabled Descemet membrane endothelial keratoplasty (FE-DMEK) in a series of patients with DALK graft failure.Methods: – A retrospective case series of eight patients who underwent FE-DMEK for failed DALK at Toronto Western Hospital.Results: – Eight eyes of eight patients (four female and four male) aged 63.91 ± 9.66 years were included. Average follow-up time after DMEK surgery was 30.0 months (range 3.8–93.1). Indications for DALK surgery were corneal dystrophy in four patients, corneal scars in two patients, and keratoconus in two patients. DALK failure was because of endothelial/stromal scarring in three patients, recurrence of corneal dystrophy in the stromal interface in three patients, endothelial decompensation in one patient, and persistent DM detachment that created a double chamber in one patient. All DMEK procedures were uneventful. Rebubbling was indicated in 5/8 (62.5%) patients, performed at a mean time of 15.6 days (range 3–26 days). Mean best-corrected distance visual acuity at 12 months and final visit was 0.37 ± 0.10 logMAR (Snellen equivalent ∼20/45) and 0.25 ± 0.16 logMAR (Snellen equivalent ∼20/35), respectively. Endothelial cell-loss rates were 39% at 1 year.Conclusions: – FE-DMEK is effective in managing DALK graft failure in selected cases. Postoperative outcomes are favorable, with detachment and rebubbling rates comparable with those reported for DMEK after failed PK.