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J. A. Chen, J. A. Alvarado, D. G. Hwang; Incidence of Glaucoma After Descemet’s Stripping Automated Endothelial Keratoplasty (DSAEK). Invest. Ophthalmol. Vis. Sci. 2008;49(13):2313.
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To determine the incidence of glaucoma following Descemet’s stripping automated endothelial keratoplasty (DSAEK).
A retrospective review was performed of a consecutive series of eyes undergoing DSAEK by a single surgeon at UCSF (DGH) from 2006-2007. Patients who underwent DSAEK after failed prior penetrating keratoplasty were excluded. For patients who received bilateral DSAEK, only the first operated eye was included. "Glaucoma" was defined as a postoperative intraocular pressure (IOP) above 21 persisting beyond 1 week and resulting in the introduction of additional medical or surgical glaucoma therapy. No attempt was made to exclude cases of a steroid-induced IOP increase. Fisher’s exact test was used to detect statistical differences between groups.
A total of 29 eyes from 29 patients were included in the final analysis. Follow-up period ranged from 1 month to 17 months (mean 7 months). Preoperative diagnoses included Fuchs’ dystrophy (15 eyes), pseudophakic bullous keratopathy (13 eyes), and aphakic bullous keratopathy (1 eye). Of the 29 eyes, 21 eyes (72.4%) had no prior diagnosis of glaucoma, and 8 (27.6%) had known pre-existing glaucoma. A total of 5 eyes (17.2%) were classified as "postoperative glaucoma," with a mean IOP increase of 11.1 mm Hg from baseline IOP. However, all 5 cases were managed with medication alone, with an average of 2.2 additional glaucoma medications required per patient. No patients required glaucoma surgery during the follow-up period. Of the 21 patients without pre-existing glaucoma, 3 (14.3%) went on to develop "postoperative glaucoma." Of the 8 patients with pre-existing glaucoma, 2 (25%) developed worsened "postoperative glaucoma." There was no significant difference between the two groups (p = 0.60).
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