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Faisal Ridha, Mona A Kaleem, Bonnielin K Swenor, Zyran Shwani, Annapurna Singh; Intraocular pressure changes after DSAEK. Invest. Ophthalmol. Vis. Sci. 2016;57(12):1217.
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© ARVO (1962-2015); The Authors (2016-present)
In recent years, Descemet’s Stripping Automated Endothelial Keratoplasty (DSAEK) has been increasingly popular over penetrating keratoplasty (PKP) in the treatment of corneal endothelial dysfunction. However, the incidence of postoperative intraocular pressure (IOP) elevation continues to be a challenge for clinicians, particularly in patients with glaucoma. The purpose of this study is to investigate the incidence of IOP elevation and ocular medication augmentations in those with and without glaucoma after DSAEK.
Records of 379 patients undergoing DSAEK at the Cleveland Clinic from April, 2006 to April, 2014 were included in this study. Demographic information included age, gender, race, corneal diagnosis, past ocular history, and use of glaucoma medications. Post-operative IOP elevations were considered significant if increased by ≥ 10 mm Hg from baseline, or ≥ 22 mm Hg on at least one follow up visit. The primary outcome measure was the incidence of IOP elevation in those with prior glaucoma versus those without. The secondary outcome was the use of glaucoma medications in each group. Cox proportional hazard models were used to determine the incidence rate ratios (IRR) and associated 95% confidence intervals (CI).
The overall incidence rate of IOP elevation was 4% in all patients with no statistically significant difference between groups. The incidence rate decreased over the course of 12 months in each category. Whites had nearly a 47% lower incidence of IOP elevation compared to non-whites (IRR=0.53; CI: 0.35, 0.81), patients with PBK had a 54% higher incidence of OHT (IRR=1.54; CI: 1.06, 2.25), while those with Fuchs had a 36% lower incidence (IRR=0.64; CI: 0.43, 0.94).Patients with prior glaucoma had two-fold higher incidence of medication augmentation compared to those without glaucoma (IRR = 2.02; CI: 1.35, 3.04). Similar to the trends for IOP elevation, the incidence rate for medication augmentation decreased in both groups over time. Those with PBK had a 90% higher incidence of needing medication augmentation (IRR=1.90; CI: 1.24, 2.91), while those with Fuchs had 46% lower incidence (IRR=0.54; CI: 0.34, 0.86). The need for medication changes did not differ by patient age or race.
The incidence of post-DSAEK IOP elevation did not significantly differ between patients with and without glaucoma. However, glaucoma patients were more likely to need medication augmentation during the 12-month follow up period.
This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.
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