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D. J. Friend, P. M. Phillips, M. A. Terry, N. Shamie, D. Doot, H. Saad; Is DSAEK Safe in Patients With Previous Glaucoma Filtering Surgeries?. Invest. Ophthalmol. Vis. Sci. 2008;49(13):2333.
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To evaluate the intra operative and post operative complications and outcomes of DSAEK in patients with previous glaucoma filtering surgeries
Retrospective case series of all patients with glaucoma filters, who underwent DSAEK at one institution
22 eyes of 20 patients were included in the study (Sixteen trabeculectomies (trabs) and 6 glaucoma drainage devices (GDDs)). Additional procedures performed included, 3 anterior vitrectomies, 2 cataract extractions with IOL placement, 1 IOL exchange, 2 sutured IOLs, 2 iridoplasties, and 2 tube revisions. Intra-operative complications included 2 compromised blebs and one loss of donor tissue do traumatic manipulation. The average post-operative follow up was 260 days (28-628 days). Post-operative complications included 1 dislocation, 1 decentered graft, one retinal detachment, 2 graft rejection episodes and one late endothelial failure. There were no primary graft failures. In 4 eyes, one or more new glaucoma drops were initiated post operatively. No additional glaucoma surgeries were performed post operatively. The average visual acuity at the last exam was 20/143, representing an improvement from pre-op (p=<.001). 21 of 22 grafts were clear at the last follow up exam and no eye lost vision. The average endothelial cell density at 6 months was 1820 (1126 - 2500) and the average cell loss was 32% (13%-55%) (n=4)
In this series, eyes with glaucoma filters lead to a significant improvement in vision with no primary graft failures and reasonably low dislocation (4.5%) and graft decentration (4.5%) rates. The overall intra-operative complication rate of 14% may, in part, be explained by the complexity of surgical procedures performed with the DSAEK. Function of glaucoma filters may be affected after DSAEK, with 18% of eyes requiring additional medical therapy post-op, however no filters failed during the post-operative period. While these are difficult surgeries, posing multiple unique challenges, excellent outcomes comparable to those seen in less complex eyes can be achieved
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