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George Papachristou, David Greenfield, Terrence O'Brien, Joyce Schiffman, Wei Shi, Shawn Iverson; Comparison Of Graft Survival Following Penetrating Keratoplasty And Descemet’s Stripping Endothelial Keratoplasty In Medically And Surgically Treated Glaucoma Patients. Invest. Ophthalmol. Vis. Sci. 2013;54(15):3074.
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To compare corneal graft survival rate after primary penetrating keratoplasty (PK) and Descemet’s stripping endothelial keratoplasty (DSEK) in patients with medically and surgically treated glaucoma.
A retrospective review of patients who underwent primary corneal transplant surgery (PK or DSEK) at Bascom Palmer Eye Institute with pre-existing glaucoma from January 1, 2005 to December 31, 2010. Inclusion criteria consisted of patients with glaucomatous optic nerve damage and visual field loss, age ≥ 18, corneal decompensation requiring corneal transplant surgery, and ≥6 months of follow-up. Only the first eye per patient was selected. Graft failure was defined as >3 months of corneal edema or opacity, resulting in loss of optical clarity correctable only by surgery. Corneal graft survival was calculated using Kaplan-Meier survival analysis and risk factors were evaluated using Cox proportional hazards analysis.
A total of 332 corneal transplants (261 PK, 97 DSEK) were performed during the study period. Fifty-five eyes (28 PK, 27 DSEK) from 55 patients (mean age 73±13 yrs in PK and 76±10 in the DSEK group, p =0.32) met the enrollment criteria and were selected for review. Glaucoma diagnoses consisted of POAG 28(51%), PXFG 12(22%), CACG 7(13%), uveitic glaucoma 4(7%), NTG 2(4%), and others 2(4%). The 1, 3, and 5-year graft survival rates in the PK group (87%, 47%, and 47%) were compared with the DSEK group (57%, 36%, and 24%) and found to be significantly higher at 1 year (p=0.009) but lost significance at subsequent follow-up (p=0.18). Among eyes which received glaucoma drainage implants (n=20), the 1, 3, and 5-year survival rates were 63%, 26%, and 26%, respectively, in the eyes with anterior chamber implants (n=15) versus 100%, 100%, and 100%, respectively, in those with pars plana placement (n=5, p=0.04).
Though patients with pre-existing glaucoma had a trend towards higher graft survival in the PK compared to the DSEK group; this difference was not found to be statistically significant. Tube placement in the anterior chamber is a significant risk factor for graft failure.
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