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D. S. Dhoot, M. A. Terry, N. Shamie, P. Phillips, D. Friend; Descemet’s Stripping Automated Endothelial Keratoplasty Outcomes in Glaucoma Patients and Steroid Responders. Invest. Ophthalmol. Vis. Sci. 2008;49(13):2318.
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To report Descemet’s stripping automated endothelial keratoplasty (DSAEK) outcomes in patients with pre-existing glaucoma, and in those patients without glaucoma who had elevated intraocular pressure (IOP) presumably due to steroid response.
Data on 365 consecutive eyes was evaluated from a prospective study on endothelial keratoplasty. Baseline visual acuity (VA) and IOP were recorded pre-operatively and compared to VA and IOP at 6 months and 1 year for patients with complete follow-up. Donor endothelial cell counts were compared to central endothelial cell density (ECD) recorded at 6 months and 1 year post DSAEK. Postoperative complications such as graft dislocation and primary graft failure were also noted. These variables were analyzed in eyes with pre-existing glaucoma and steroid responders as individual sub-groups and compared to the remaining eyes, which served as controls.
Of the 365 eyes that underwent DSAEK, 36 had pre-existing glaucoma, 19 were steroid responders, and the remaining 310 served as controls. No significant difference in ECD, rate of dislocation, or IOP during the protocol visit dates was seen among the 3 groups. Visual acuity outcomes were, however, significantly different among the groups. The mean VA for the glaucoma eyes was 20/333 (pre-op), 20/91 (6 months), and 20/71 (1 year). The mean VA for steroid responders was 20/77 (pre-op), 20/50 (6 months), and 20/95 (1 year). Mean VA for control eyes was 20/80 (pre-op), 20/33 (6 months), and 20/32 (1 year). A significant difference in VA was seen when comparing glaucoma eyes to controls at pre-op (p <0.001), 6 months (p<0.001), and 1 year (p<0.001). There was a significantly greater improvement in VA in the glaucoma group compared to control at 6 months and 1 year (p <0.001). When comparing steroid responders to controls a significant difference was seen in VA at 6 months (p=0.001) and 1 year (p<0.001), but not at pre-op.
To our knowledge, these are the first results of DSAEK outcomes reported among patients with glaucoma and steroid responders, specifically. Our data shows no difference in IOP, ECD, and dislocation rate up to 1 year following surgery in these groups when compared to control. Steroid responders can be expected to have significantly worse visual outcomes, in general. Glaucoma patients undergoing DSAEK can be expected to have similar post-surgical results to non-glaucomatous patients, with greater line improvement in their post-operative vision.
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