Abstract
Purpose: :
To evaluate the intra operative and post operative complications and outcomes of DSAEK in patients with previous glaucoma filtering surgeries
Methods: :
Retrospective case series of all patients with glaucoma filters, who underwent DSAEK at one institution
Results: :
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)
Conclusions: :
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
Keywords: transplantation • cornea: endothelium • trabecular meshwork