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A double Descemet’s stripping endothelial keratoplasty on a penetrating keratoplasty
  1. Li Yen Goh1,2,
  2. Mohamed Elalfy3,
  3. Noha Mohamed Ghoz3,
  4. Harminder Dua4
  1. 1 Ophthalmology, Kingston Hospital NHS Trust, Kingston upon Thames, London, UK
  2. 2 Academic Section of Ophthalmology and Visual Sciences, Nottingham University Hospitals NHS Trust, Nottingham, UK
  3. 3 Academic Section of Ophthalmology and Visual Sciences, Nottingham University Hospitals NHS Trust, Nottingham, UK
  4. 4 Ophthalmology, University Hospital, Nottingham, UK
  1. Correspondence to Dr Li Yen Goh, liyengoh{at}


A patient with keratoconus underwent a penetrating keratoplasty (PK) in his right eye. This failed after 12 years following phacoemulsification surgery. A Descemet's stripping endothelial keratoplasty (DSEK) was carried out which failed and detached after 4 months. Subsequently, a second DSEK was performed which failed after 2 months but remained attached. This graft was retained in the cornea and a third DSEK button was placed without removing the failed DSEK graft. The cornea cleared well and patient’s vision was 6/9 at 18 months postsurgery. Optical coherence tomography showed the two DSEK grafts closely applied to each other and to the recipient cornea. Stripping a failed DSEK graft performed for a previous failed PK carries the risk of internal dehiscence of the PK graft–host junction. This was avoided by placing the second DSEK graft on the failed previous DSEK graft with good visual outcome indicating that this option can be clinically considered.

  • anterior chamber
  • ophthalmology
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  • Contributors LYG, ME, NMG and HD were involved in the conception, design and acquisition of data; were involved in drafting the manuscript and revising it critically for publication purposes; have approved the current submitted version of the manuscript; are in agreement to be held accountable for the article and will ensure that all questions regarding the accuracy or integrity of the article will be investigated and resolved.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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