Abstract
Purpose:
To compare the outcome of Descemet stripping automated endothelial keratoplasty (DSAEK) in eyes with simultaneous insertion of a glaucoma drainage device (GDD), simultaneous repositioning of a GDD through the pars plana, previous insertion of a pars plana GDD and previous insertion of an anterior chamber GDD.
Methods:
A retrospective chart review was conducted on 43 eyes that underwent DSAEK by two surgeons with either simultaneous insertion of a GDD, simultaneous repositioning of a GDD through the pars plana, previous insertion of a pars plana GDD or previous insertion of an anterior chamber GDD (6, 12, 14, 11 eyes, respectively). All patients had accrued 3 or more months of follow-up at the time of analysis. Outcome measures examined included donor dislocation rate, intraocular pressure and graft survival. Mean time of follow-up was 30 months.
Results:
In eyes with simultaneous insertion of a GDD, simultaneous repositioning of a GDD through the pars plana, previous insertion of a pars plana GDD and previous insertion of an anterior chamber GDD, donor detachment occured in 17%, 33%, 50%, 36% of eyes respectively. In total, donor detachment occurred in 37% of eyes. Escalation of glaucoma therapy was required in 0%, 25%,23%. and 36% of eyes respectively. Escalation of glaucoma therapy was required postoperatively in 24% of all eyes. The probability of graft survival at 3 years was 44%, 31%, 67%, 61% respectively. Overall cumulative probability of graft survival at 3 years was 48%.
Conclusions:
Eyes that underwent simultaneous insertion of a GDD at the time of DSAEK seem to have a lower incidence of donor detachment and better control of glaucoma than other groups. Probability of graft survival was higher in the previous insertion of a pars plana and anterior chamber GDD groups than the simultaneous insertion of a GDD and simultaneous repositioning of a GDD through the pars plana groups. Larger sample size is needed confirm these hypotheses.