Abstract
Purpose: :
(1) To compare the rate of complications after Descemet stripping with automated endothelial keratoplasty (DSAEK) in patients with no glaucoma and glaucoma. (2) To identify risk factors for postoperative complications.
Results: :
Preoperative 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%). 40% had preexisting glaucoma and 56.3% of those received glaucoma surgery. Five-year overall complication rates were: detachment (13.3%), graft failure (16.1%), pupillary block (2.8%) and IOP elevation (21.9%). Preoperative etiologies of corneal edema were not associated with increased risk of graft detachment, pupillary block, or IOP elevation (p > 0.05). FED had a lower RR of graft failure compared to the other groups, 0.382 [0.16 - 0.93], p = 0.023. Pupillary block and IOP elevation were not related with any group. Graft detachment and IOP elevation were two independent risk factors for graft failure, with detachment a more significant contributor. Coexisting glaucoma significantly increased risk of graft failure. Glaucoma had higher risk of graft failure compared to non-glaucoma, RR = 2.61, 95% CI 1.56. History of glaucoma surgery conferred a higher risk compared to glaucoma only on drops (RR = 2.07, 95% CI [1.05 - 4.08], p = 0.045).
Conclusions: :
DSAEK has emerged as the preferred treatment for corneal endothelial dystrophy. In this series of 316 cases over five year, pseudophakia / aphakia, coexisting glaucoma, history of glaucoma surgery, postoperative graft detachment or detachment, and postoperative IOP elevation were identified as risk factors for graft failure.
Keywords: cornea: endothelium • cornea: clinical science • transplantation