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Carrie Zaslow, Paul Petrakos, Allison Angelilli, Ira Udell, Carolyn Shih; Risk Factors for Adjuvant Glaucoma Therapy and Graft Failure in Descemet’s Stripping Automated Endothelial Keratoplasty Patients. Invest. Ophthalmol. Vis. Sci. 2013;54(15):3093.
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To assess the incidence of medical or surgical escalation of intraocular pressure (IOP) management after Descemet’s Stripping Automated Endothelial Keratoplasty (DSAEK) in patients with and without pre-existing glaucoma and association of this escalation with graft failure.
Retrospective cohort study of 195 DSAEK grafts performed at a tertiary medical center between January 2007 and August 2012.
71 grafts were performed in eyes that had required surgical or medical management of elevated intraocular pressure prior to DSAEK. 22 were performed in eyes that had previous glaucoma surgery including trabeculectomy and/or tube implant. One graft was performed concomitantly with a tube implant. 11 eyes with preexisting glaucoma required glaucoma valve implant within 24 months after DSAEK as compared to only one eye without preexisting glaucoma (p<0.0003). 31 (46.5%) grafts in eyes with preexisting glaucoma required addition of drops after DSAEK for intraocular pressure management as compared to 23 (18.5%) grafts in eyes without pre-existing glaucoma (P<.0002). Failure occurred in 17/71 (23.9%) of grafts in eyes with pre-existing glaucoma; 7 had glaucoma surgeries prior to DSAEK, 3 of which had a tube revision performed concomitantly with DSAEK. 4/7 required rebubbling and 1/7 had hypotony postoperatively. 5/17 of the grafts that failed were performed in eyes that required subsequent glaucoma tubes after DSAEK. 3 of these 5 had intra- or postoperative complications during tube placement including choroidals in 2 eyes and malignant glaucoma in 1 eye. In comparison, of 124 eyes without glaucoma, 6 (4.8%) DSAEKs went on to failure; all without adjuvant IOP management following DSAEK. 5/124 (4%) eyes required rebubbling. Of these, 2/5 went on to failure.
Adjuvant medical or surgical therapy is more likely to be needed after DSAEK in patients with a pre-existing history of glaucoma. Prior glaucoma surgery may be a risk factor for failure of DSAEK grafts.
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