Management of endothelial failure after non-stripping descemet membrane endothelial keratoplasty (NS-DMEK) under previous penetrating keratoplasty (PKP), a case report

Repeated endothelial failure following penetrating keratoplasty (PKP) and Descemet membrane endothelial keratoplasty performed without host descemetorhexis (ns-DMEK) poses a unique challenge. We report a case of a 66-year-old pseudophakic woman with a piggyback toric implantable Collamer lens who presented with a third endothelial failure after a prior PKP and ns-DMEK for Fuchs Endothelial Dystrophy. The patient was successfully managed with a second ns-DMEK without removal of the two failed Descemetic layers. Two-year follow-up showed restored visual acuity (20/100 to 20/25), corneal transparency, and normal pachymetry, with no intraoperative or postoperative complications, suggesting that host descemetorhexis may be unnecessary in selected cases.