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Pho Nguyen, Shabnam Khashabi, Farnaz Memarzadeh, Vikas Chopra, Brian A. Francis, Martin Heur, Jonathan C. Song, Samuel C. Yiu; Recipient Risk Factors for Complications after Descemet Stripping with Endothelial Keratoplasty. Invest. Ophthalmol. Vis. Sci. 2011;52(14):777.
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(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.
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).
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.
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