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E. W. Chan, J. S. Mehta, T. T. Wong, H. M. Htoon, C. L. Ho, D. T. Tan, D. T. Tan; De Novo Glaucoma After Descement’s Stripping Automated Endothelial Keratoplasty: A Case Series in Asian Eyes. Invest. Ophthalmol. Vis. Sci. 2009;50(13):626.
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Descemet’s stripping automated endothelial keratoplasty (DSAEK) is a leading surgical strategy in managing corneal endothelial disorders but de novo glaucoma as a post-DSAEK complication has not been evaluated. We aim to investigate the incidence, clinical features and outcomes of de novo glaucoma following DSAEK.
We retrospectively reviewed 121 DSAEK procedures performed for corneal decompensation secondary to Fuchs endothelial corneal dystrophy (FECD) and pseudophakic bullous keratopathy (PBK) between April 2006 to November 2008 and identified patients with de novo glaucoma. We collected data on visual acuity and intraocular pressure (IOP) from baseline until end of follow-up, glaucoma management and graft survival. Potential prognostic factors for glaucoma control were evaluated.
De novo glaucoma occurred for 18 grafts (14.9%) of 18 patients during a mean follow-up of 10.7 months. 10 grafts were performed for FECD and 8 for PBK. Mean time to onset of glaucoma was 5.8 ± 6.2 months. 6 patients (33.3%) had peripheral anterior synechiae (PAS) and 1 patient had pupil-block. Antiglaucoma medications were administered in all patients, however 5 patients (27.8%) subsequently required trabeculectomy. Laser peripheral iridotomy was performed in 3 patients (16.7%). 3 patients (16.7%) had graft failure, which developed before onset of glaucoma in 2 patients. Mean IOP at end of follow-up was 16 mm Hg. Patients with PAS had a significantly higher requirement for trabeculectomy for glaucoma control than in patients who did not have PAS (66.7% vs. 8.3%, p=0.028)
De novo glaucoma occurred in 14.9% of DSAEK grafts but with appropriate management, the risk of graft failure from raised IOP was low. More importantly, we found the presence of PAS to be a prognostic indicator for the requirement of trabeculectomy. This is an important clinical consideration in Asian eyes undergoing DSAEK which generally have a propensity for narrow angles.
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