Corneal Graft Survival and Intraocular Pressure Control after Descemet Stripping Automated Endothelial Keratoplasty in Eyes with Pre-existing Glaucoma

ArticleinAmerican Journal of Ophthalmology 152(1):48-54.e2 · May 2011with9 Reads
DOI: 10.1016/j.ajo.2011.01.030 · Source: PubMed
Abstract
To describe the effect of Descemet stripping automated endothelial keratoplasty (DSAEK) on intraocular pressure (IOP) and corneal graft survival in eyes with pre-existing glaucoma or ocular hypertension. Retrospective, observational case series. We performed a retrospective review of 184 eyes that underwent DSAEK from January 2007 through May 2009 at the Singapore National Eye Centre. Eyes with pre-existing glaucoma or ocular hypertension that underwent DSAEK were included, whereas those with a follow-up period of less than 12 months were excluded. Main outcome measures were graft failure and need for additional IOP-lowering treatment after DSAEK. Forty-seven eyes (51% male; mean age, 66.6 years) with glaucoma underwent DSAEK and were followed-up for a mean of 27.3 ± 8.5 months. Before DSAEK, 60% were taking at least 1 topical IOP-lowering medication, whereas 14 eyes (30%) previously had undergone glaucoma filtration surgery. After DSAEK, visual acuity improved by a mean of 5.4 ± 3.7 Snellen lines. Seventeen percent of grafts failed at a mean of 12.8 ± 7.0 months. The mean IOP increased by 2.1 mm Hg to 16.0 ± 2.5 mm Hg, with 62% requiring additional IOP-lowering treatment and 28% needing filtration surgery at a mean of 9.3 months after DSAEK. Eyes without prior filtration surgery and eyes that underwent additional intraoperative procedures during DSAEK were 10 and 18 times more likely to require IOP-lowering treatment after DSAEK (P = .002 and P = .008), respectively. With prompt and appropriate intervention, IOP in glaucomatous eyes undergoing DSAEK can be controlled with minimal increase after DSAEK. Eyes with previous filtration surgery require fewer medications to control elevated IOP than eyes that have not had previous surgery.
    • "Our limited result showed even lower complication rate. Quek et al. [16] retrospectively analyzed 47 eyes with pre-existing glaucoma which underwent DSAEK and reported that IOP in glaucomatous eyes undergoing DSAEK can be controlled with minimal increase after DSAEK and eyes with previous filtration surgery required fewer medications to control elevated IOP than eyes that had not had previous surgery. Esquenazi et al. [17] and Riaz et al. [18] each reported 1 patient with prior Ahmed glaucoma valve implantation who underwent DSAEK successfully with good IOP control and graft survival. "
    [Show abstract] [Hide abstract] ABSTRACT: To evaluate the outcomes of Descemet-stripping automated endothelial keratoplasty (DSAEK) with the use of continuous air pumping technique in Asian eyes with previous Ahmed glaucoma valve implantation. The DSAEK procedure was modified in that complete air retention of the anterior chamber was maintained for 10 min using continuous air pumping at 30 mm Hg. The primary outcome measurement was graft survival, and postoperative clinical features including, rate of graft detachment, endothelial cell count, intraocular pressure (IOP), surgical time and cup/disc ratio were also recorded. A total of 13 eyes of 13 patients which underwent modified DSAEK and 6 eyes of 6 patients which underwent conventional DSAEK were included. There was a significant difference in graft survival curves between two groups (P = 0.029); the 1-year graft survival rates were estimated as 100% and 66.7% for patients with modified DSAEK and those with traditional DSAEK, respectively. The rate of graft detachment were 0% and 33.3% for the modified DSAEK and conventional DSAEK groups, respectively (P = 0.088). The significantly lowered surgical time for air tamponade was noted in the modified DSAEK group compared to that in the conventional DSAEK group [median (IQR): 10.0 (10.0, 10.0) min vs. 24.5 (22.0, 27.0) min; P<0.001] Postoperatively, patients in the modified DSAEK group had significantly lower IOP as compared to the conventional DSAEK group [12.0 (11.0, 15.0) mm Hg vs. 16.0 (15.0, 18.0) mm Hg; P = 0.047]. Modified DSAEK patients had higher endothelial cell counts as compared to conventional DSAEK patients [2148.0 (1964.0, 2218.0) vs. 1529.0 (713.0, 2014.0)], but the difference did not reach statistical significance (P = 0.072). New continuous air pumping technique in DSAEK can be performed safely and effectively in patients with prior GDDs placement who have corneal failure.
    Full-text · Article · Aug 2013
  • [Show abstract] [Hide abstract] ABSTRACT: Tina Wong, FRCOphth, FRCSEd, PhD, is a consultant in the Glaucoma Service at the SNEC, and Head of Ocular Drug Delivery Research Group at the Singapore Eye Research Institute. Her interests are ocular drug delivery, post-operative wound healing, and primary angle closure glaucoma. She holds faculty positions at the National University Hospital, and the School of Materials Science and Engineering at the Nanyang Technological University, Singapore. She is a member of the World Glaucoma Association.
    Article · Mar 2012
  • [Show abstract] [Hide abstract] ABSTRACT: To evaluate long-term corneal graft survival and risk factors for graft failure after Descemet's stripping endothelial keratoplasty (DSEK) in eyes with preexisting glaucoma. Retrospective case control study. A total of 835 DSEK cases performed by a single surgeon between December 2003 and August 2007 were reviewed. Only the first treated eye of each patient with at least 1 year follow-up was included, resulting in 453 cases; 342 had no prior glaucoma (C), 65 had medically managed preexisting glaucoma (G), and 46 had prior glaucoma surgery (GS). Corneal graft failure was defined as persistent corneal edema resulting in irreversible loss of optical clarity. Corneal graft survival in the 3 groups was calculated using Kaplan-Meier survival analysis. Nine potential risk factors for graft failure were evaluated by Cox proportional hazards univariate and multivariate analysis. These methods took length of follow-up into consideration. Corneal graft survival and risk factors influencing long-term corneal endothelial failure. The 1-, 2-, 3-, 4-, and 5-year graft survival was 99%, 99%, 97%, 97%, and 96%, respectively, in group C; 100%, 98%, 98%, 96%, and 90%, respectively, in group G; and 96%, 91%, 84%, 69%, and 48%, respectively, in group GS (P < 0.001). In the GS group, the 5-year survival rate for eyes with a glaucoma drainage device (GDD) and those with trabeculectomy only was 25% and 59%, respectively. Indication for DSEK, surgically managed glaucoma, type and number of prior glaucoma surgeries, and occurrence of a rejection episode were the significant risk factors for graft survival in univariate analysis. Several factors were correlated; in a multivariate model, prior glaucoma surgery (P < 0.0001) and a prior rejection episode (0.0023) were the significant risk factors for corneal endothelial failure. Patients with medically managed glaucoma had significantly better 5-year graft survival than those with surgically managed glaucoma. A prior glaucoma shunt or trabeculectomy significantly increased the risk of DSEK endothelial failure. Proprietary or commercial disclosure may be found after the references.
    Full-text · Article · Jun 2012
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