View abstract

This abstract is assigned to session AOB Free Papers 2

Presentation type	Oral presentation
Title	Case report: DALK followed by DMEK

Purpose	To present a staged surgical approach consisting of deep anterior lamellar keratoplasty (DALK), subsequent Descemet membrane endothelial keratoplasty (DMEK), and cataract surgery to achieve rapid visual rehabilitation after infectious keratitis.
Methods	A 53-year-old man developed a visually significant stromal scar after successful treatment of Pseudomonas keratitis in the right eye, resulting in a best-corrected visual acuity (BCVA) of seeing hand movements. In April 2025, DALK was performed because of lack of significant stromal edema. Postoperatively, corneal edema persisted due to endothelial failure. DMEK was performed in August 2025 to restore endothelial function. This enabled earlier cataract surgery, as PK would have required prolonged refractive stabilization. After successful rebubbling, the remaining visual impairment was attributed to cataract. Phacoemulsification with intraocular lens implantation was performed in March 2026.
Results	Final BCVA improved to 0.8+2 with optimal refraction (+0.50D / −3.00D@170°). Apart from rebubbling after DMEK and temporary postoperative positive Seidel sign requiring scleral wound suturing, no further complications occurred. The patient was highly satisfied with the visual outcome.
Conclusion	DMEK may serve as a rescue procedure for endothelial failure following DALK, preserving the original lamellar graft and avoiding conversion to penetrating keratoplasty. Although primary PK was a valid alternative, this case demonstrates the feasibility of this sequential approach. To our knowledge, this rescue strategy has not previously been described.
Conflict of interest	No

Authors 1

Last name	MYLEMANS
Initials	E
Department	Universiteit Antwerpen / Universitair Ziekenhuis Antwerpen
City	Antwerpen

Authors 2

Last name	Mooren
Initials	P
Department	Universitair Ziekenhuis Antwerpen
City	Antwerpen