Purchase this article with an account.
Brenton D Finklea, Nina Ni, Brian J Sperling, Sadeer B Hannush; Three-Year Follow Up of DSAEK Failure Rates and Endothelial Cell Loss in Eyes with Glaucoma Drainage Devices. Invest. Ophthalmol. Vis. Sci. 2015;56(7 ):1565.
Download citation file:
© ARVO (1962-2015); The Authors (2016-present)
To provide updated data on graft failure rate and endothelial cell loss after Descemet’s stripping automated endothelial keratoplasty (DSAEK) in eyes with previous glaucoma drainage devices (GDD).
A retrospective review of 25 cases in 22 eyes with prior GDDs undergoing DSAEK. Outcome measures included graft failure rate, graft dislocation rate, and post-operative corneal endothelial cell loss. Primary graft failure was defined as an edematous corneal graft that either failed to deturgesce in the first month after surgery or failed to adhere to the host stroma. Secondary graft failure was defined as a graft that cleared initially, then became edematous and unresponsive to medical therapy, requiring repeat surgical intervention.
The study cohort showed no cases of primary graft failure. Secondary graft failure occurred in 48% of grafts with an average time to failure of 33.3 ± 16.8 months over our mean follow-up period of 36.1 months. Graft dislocation occurred in 12% of eyes, all of which were successfully re-bubbled. Compared to the endothelial cell count (ECC) at the time of transplantation, graft ECC decreased by 49.3% ± 16% at 3 months, 59.2 ± 16% at 6 months, 61% ± 21% at 12 months, 74.8% ± 17% at 18 months, 75.3% ± 19% at 24 months, 78.7% ± 8% at 30 months, and 74.8 ± 14% at 36 months.
DSAEK is an effective procedure in many eyes with corneal edema secondary to endothelial dysfunction. The procedure may be complicated by the presence of a prior GDD because of the frequent inability to raise the pressure in the eye adequately to achieve effective air tamponade. In this study we redemonstrate the significant incidence of intermediate term endothelial cell loss and secondary graft failure in eyes undergoing DSAEK with prior GDDs.
This PDF is available to Subscribers Only