Abstract
Purpose: :
To compare the outcome of intraocular pressure (IOP) control in glaucoma patients who have undergone DSAEK to those that have undergone PKP for the same clinical indications.
Methods: :
A retrospective chart review of patients with glaucoma from the Robert Cizik Eye Clinic that underwent DSAEK or PKP from January 2001 to December 2009 for aphakic bullous keratopathy, pseudophakic bullous keratopathy, or Fuch’s endothelial dystrophy. Baseline ocular characteristics including IOP, number of IOP lowering medications, prior trabeculectomy, and tube shunt implantation were collected. IOP and number of IOP lowering medications at months 3, 6, 12 and 24 postoperatively were recorded. Dates of graft failure and tube shunt implantation during the follow-up were noted. Uncontrolled IOP was defined as 2 or more consecutive visits with IOP greater than baseline, greater number of IOP lowering medications from baseline or surgical intervention for IOP lowering during follow-up. Elapsed time from date of study procedure to uncontrolled IOP was calculated and censored at the time of graft failure or last follow-up. Kaplan-Meier survival analysis was used to compare survival curves between DSAEK and PKP.
Results: :
Thirty-seven eyes of 34 subjects, aged 62 ±18 years (range 20 to 89) were included. Twenty-three eyes underwent DSAEK, and 14 eyes underwent PKP. Six (26%) eyes in the DSAEK group and 5 (36%) eyes in the PKP group had prior trabeculectomy. Nine (37%) eyes in the DSAEK group and 6 (33%) eyes in the PKP group had previous tube shunts. At baseline, there was no difference in IOP (15 ± 4 mmHg in the DSAEK group vs 18 ± 8 mmHg in the PKP group) or IOP lowing medications between the groups. Postoperatively, 7 (30%) DSAEK and 5 (36%) PKP eyes experienced a failed graft. Uncontrolled IOP was found in 13 (56%) DSAEK and 7 (50%) PKP eyes. The survival curves for IOP control were no different between 2 groups using log rank test (P=0.2820).
Conclusions: :
DSAEK is a viable surgical option for patients with preexisting glaucoma and IOP is equally likely to rise regardless of which procedure is performed.
Keywords: intraocular pressure • transplantation • cornea: endothelium