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    Finding alternative techniques for eyes with failed PK


    DMEK as another option

    The opportunity to perform DMEK in eyes with failed PK also argues against repeating PK.

    “If we are able to repeat a corneal transplant in an eye with a previous PK, most of the time it is because the PK failed due to allograft rejection. Then it makes sense to choose a procedure that clearly has the lowest risk of graft rejection,” said Dr. Tan, presenting data showing that DMEK and deep ALK have higher 5-year survival rates than PK and DSAEK.

    “There are techniques that will help us to do DMEK for failed grafts, such as the hybrid DMEK,” he said.

    Also telling are data from the SCTS that show a 5-year survival rate of 5 years after DMEK, which is higher than for the other keratoplasty alternatives.

    In addition, the rate of secondary glaucoma after DMEK was just 10% compared with 24% for both DSAEK and PK.

    The explanation is that DMEK eyes require less topical corticosteroid treatment postoperatively, Dr. Tan said.

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