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Shabnam Khashabi, Pho Nguyen, Farnaz Memarzadeh, Vikas Chopra, Brian Francis, Martin Heur, Jonathan Song, Samuel Yiu; 12-Month Visual Outcome and Intraocular Pressure after Descemet's Stripping with Automated Endothelial Keratoplasty. Invest. Ophthalmol. Vis. Sci. 2011;52(14):760.
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© ARVO (1962-2015); The Authors (2016-present)
To compare visual outcome and intraocular pressure (IOP) after Descemet’s stripping with automated endothelial keratoplasty (DSAEK) in patients with and without glaucoma.
Retrospective case series of 316 eyes undergoing DSAEK in 280 patients (pts). Visual acuity (VA) and IOP were recorded for pts undergoing DSAEK as performed by 4 corneal specialists at Doheny. A total of 191 pts were included and classified into non-glaucoma (C; 70), medical glaucoma (G; 78), and surgical glaucoma (GS; 43) groups.
Preop diagnoses included Fuchs’ endothelial dystrophy (FED, 22.2%), pseudophakic bullous keratopathy (PBK, 43.4%), combined FED and PBK (16.8%), and corneal decompensation from other etiologies (17.7%). Ocular comorbidities included diabetic retinopathy (8%), age-related macular degeneration (5.4%), neovascular macular degeneration (1.1%), advanced glaucoma (5%), retinal detachment (3.2%), band keratopathy (1.1%), giant cell arteritis (0.4%), and amblyopia (1.4%). At post-op month (POM) 12, mean best-corrected logMAR VA improved from 1.09 to 0.52, 1.25 to 0.61, and 1.69 to 1.08, in the C, G and GS groups, respectively, (P<0.05). Preexisting ocular comorbidities contributed to suboptimal mean VA. Mean IOP remained higher in the G group versus the C and GS groups, P<0.05. Mean IOP appeared to increase at POM 3. No significant increase was seen when comparing POM 3 to preop IOP, P>0.05; but a significant increase was observed when comparing POM 3 to postop week 1 in the C and GS groups, P<0.05, but not the G group, P>0.05. Magnitude of IOP elevation was 1.93 mmHg for C and 3.18 mmHg for GS. The percentage of pts with IOP elevation at POM 1,3,6, and 12 is 4.7%, 8.9%, 5.2% and 2.1%, respectively.
12-month data show that DSAEK provides good visual recovery in patients with FED and PBK. There is a high prevalence of IOP elevation, likely from steroid response, in this cohort. Further investigations recommended to see if pts with glaucomatous optic neuropathy require aggressive IOP management.
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