Purpose of review: Descemet's stripping endothelial keratoplasty (DSEK) has become a preferred surgical correction for endothelial dysfunction. Patient dissatisfaction secondary to refractive error is emerging as a significant complaint after anatomically successful DSEK. This article reviews refractive surgeries after DSEK to address this problem.
Recent findings: There are various surgical options available to treat refractive compromise following DSEK. Cataract extraction with intraocular lens (IOL) implantation is a well tolerated option to restore visual acuity after DSEK in cases with significant lens opacities. Laser in-situ keratomileusis (LASIK) and photorefractive keratectomy (PRK) can otherwise successfully correct simple refractive errors. Phototherapeutic keratectomy (PTK) may be employed in cases wherein visually significant subepithelial fibrosis and scarring become evident after DSEK.
Summary: To obtain maximum visual rehabilitation, patients undergoing DSEK may require further refractive surgeries. Cataract extraction, LASIK, PRK, PTK, and various combination procedures have been shown to optimize corneal clarity and visual acuity in patients who previously had successful DSEK with subsequent refractive errors. Technological advancements and continued research are necessary to perfect optimal timing and outcomes of these secondary refractive surgeries.