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M. S. Floyd, J. E. Sutphin, Jr.; Descemet’s Stripping Automated Endothelial Keratoplasty (DSAEK) and Glaucoma: A Retrospective Review of Treatment Outcomes. Invest. Ophthalmol. Vis. Sci. 2010;51(13):757.
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To evaluate intraocular pressure control (IOP) and graft survival after undergoing DSAEK among patients with no history of glaucoma, development of ocular hypertension, and prior glaucoma.
A retrospective chart review was conducted on 60 patients who underwent suture pull-through DSAEK at the Kansas University Medical Center. Best corrected visual acuity, endothelial cell count, IOP, and ocular medicines were recorded over a 12 month period. Significant IOP elevations is defined by IOP greater than 24 mmHg or 10 mmHg above baseline. Significant vision loss is defined as more than 3 lines.
38 eyes underwent DSAEK for Fuch’s Dystrophy, 6 for pseudophakic bullous keratopathy, 7 for edema, 6 for failed graft, and 3 for posterior polymorphous dystrophy. 41 had no diagnosis of glaucoma, 10 developed elevated IOP, and 9 had glaucoma. 2 normal and 1 glaucoma patients developed primary failure. The average initial and final acuity is 20/100 and 20/30 for normals, 20/70 and 20/60 for elevated IOP, and 20/400 and 20/60 for glaucoma. All patients with glaucoma maintained IOP with their previous medicines. The majority of the patients with IOP elevations had their prednisolone switched to Lotemax. Three were treated with a prostaglandin analogue and two with β blocker. 3 of 10 lost acuity. None of the glaucoma patients lost acuity. 2 of 43 normal patients experienced acuity loss. The average percent endothelial cell loss was 52.4% for normals, 51.8% for elevated IOP, and 53% for glaucoma. The 3 patients with elevated IOP and vision loss had IOP elevations greater than 10 mmHG within 6 months and endothelial losses of 62.1%, 68.9%, and 47.8%. The average IOP reduction with a prostaglandin analogue was 22.9% and beta blocker was 65.3%.
Patients who undergo DSAEK and develop acutely elevated IOP are at greater risk for endothelial cell loss and diminished acuity. The best topical medicine for IOP elevations may be a β blocker. This is a small retrospective study and requires further study.
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