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Jayne Weiss, Shalin Shah, Hilary Thompson, Christina Bovone; DSAEK for Corneal Decompensation After Ex-Press Shunt Surgery -A Case Series. Invest. Ophthalmol. Vis. Sci. 2013;54(15):3089.
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Corneal decompensation is a known risk of anterior chamber implantation of older glaucoma shunts (Ahmed, Baerveldt, Molteno). There is little literature discussing this association of this risk with Ex-press shunts. The purpose of the study was to determine whether the Ex-Press shunt implantation could be associated with development of subsequent corneal decompensation and whether DSAEK surgery could be successfully performed in such cases.
A retrospective case review from one corneal surgeon of all cases of DSAEK performed since 2005 that had prior Ex-Press shunt surgery. Ocular history including number of surgical procedures, intraocular pressure prior to and after Ex-Press shunt, best corrected visually acuity (BCVA) before Ex-Press shunt surgery, before and after DSAEK, and surgical complications were reviewed.
The average age and average intraocular pressures (IOP) prior to of Ex-Press shunt placement was 63.8 years +/- 3.4 standard deviation (SD) and 24.60 mmHg +/- .40 SD respectively. BCVA prior to Ex-Press shunt placement was log MAR 0.64 +/-.16 SD. The average post-operative IOP after Ex-Press shunt was 16.80 mmHg +/- 1.0 SD. The mean number of surgeries prior to DSAEK was 2.8 +/- 1.64. 4 of the 5 patients with corneal decompensation after Ex-Press shunt placement had one or more prior filtering procedures with a mean of 1.75 +/- .83. One of these patients also had 2 prior failed Ex-Press shunts. Vision decreased to count fingers in all patients before DSAEK. The average age at which significant corneal decompensation was identified and DSAEK was performed was 66.0 years +/- 3.2 SD. with average time of onset of corneal edema after Ex-Press shunt of 2.2 years +/- .44 SD. The average BCVA after DSAEK was .78 +/- .18 SD with decreased vision resulting from optic nerve damage in all cases. All corneas remained clear. IOP was controlled in 4 patients, 1 patient required cyclocrytherapy for IOP control.
This is the first case series documenting corneal decompensation after Ex-Press shunt placement. Long term follow up of patients who have had Ex-Press shunt surgery is needed to determine if the shunt device itself increases the risk of corneal decompensation. This case series demonstrates that DSAEK surgery can be successful in treatment of corneal decompensation after Ex-Press valve placement.
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