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Elizabeth M. Grace, Marianne O. Price, Francis W. Price, Jr., Jacob T. Wilensky, Thasarat S. Vajaranant; Survival of Glaucoma Surgery After Descemet's Stripping Endothelial Keratoplasty. Invest. Ophthalmol. Vis. Sci. 2011;52(14):654.
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To evaluate the outcomes of glaucoma surgery in patients with preexisting trabeculectomy or glaucoma drainage device after Descemet’s stripping endothelial keratoplasty (DSEK), based on the Tube versus Trabeculectomy Study definition of success and failure among this group of patients.
Retrospective chart review from a total of 1446 DSEK cases performed by a single surgeon (FWP) from December 2003 to July 2010 were available in the database. Study patients included in the analysis had pre-existing glaucoma surgery of trabeculectomy and/or glaucoma drainage device (GDD) before DSEK and a minimum 3 month follow-up. Kaplan-Meier (KM) survival analysis was used to describe the failure rates of glaucoma surgery, based on Tube versus Trabeculectomy (TVT) Study (IOP >21 mm Hg, IOP <6 mm Hg, reoperation for glaucoma). Details of the post-operative IOP, supplemental medical therapy, and complications of the study patients were evaluated.
Thirty four patients (20 trabeculectomy, 9 GDD, 5 trabeculectomy and GDD) qualified with a history of one or more glaucoma surgeries performed before DSEK. KM survival plot shows the probability of the glaucoma surgery survival after having a DSEK (Figure 1) was 94% at 3 months, 90% at 6 months, 67% at 12 months, 56% at 24 months, 49% at 36 months. The patients' pre-operative IOP and number of glaucoma medications were not significantly different during the three year follow-up after DSEK.
This series describes the outcomes of patients with previous glaucoma surgery undergoing a DSEK, in terms of IOP, glaucoma medications, and failure of glaucoma surgery based on the TVT Study definition. Based on the Kaplan-Meier plot, patients appear to have a higher risk of glaucoma surgery failure after DSEK in the first two years after surgery. Though larger study numbers and longer follow-up time is needed to elucidate this result further, clinicians should warn patients of the increased risk of glaucoma surgery failure after DSEK.
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