Increased rates of descemet's stripping automated endothelial keratoplasty [dsaek] graft failure and dislocation in glaucomatous eyes with aqueous shunts

To investigate the rates of Descemet's stripping automated endothelial keratoplasty [DSAEK] graft dislocation and failure in glaucomatous eyes, including eyes with history of trabeculectomy and/or aqueous shunts. A retrospective, case-control study on a total of 424 consecutive eyes undergoing DSAEK at an academic setting compared 96 glaucomatous eyes to a control group of 328 eyes. Pre- and post DSAEK procedure data was aggregated for up to 2 years [mean follow-up, 6.5 +/- 6.9 months] including rates of graft dislocation and failure. Out of 96 glaucomatous eyes, 20 had undergone trabeculectomy, 27 had received one or more aqueous shunts, 12 had undergone both procedures and 37 were on medical therapy. Complete DSAEK graft dislocation and failure occurred in 2.7% and 3% of non-glaucomatous patients, respectively. Eyes with history of aqueous shunt surgery experienced graft dislocation and failure rates of 26.0% [OR=4.6, 95% CI 1.5-13.7, p=0.0067] and 26.0% [OR=10.3, 95% CI 3.8-27.1, p<0.0001], respectively. In contrast, glaucomatous eyes only on medical therapy [p=0.13] or with history of trabeculectomy [p>0.40] had no significant increase in graft dislocation or failure rates. Eyes with medically controlled glaucoma or prior trabeculectomy demonstrated comparable rates of graft dislocation and failure as compared to controls. Aqueous shunt surgery was associated with increased rates of graft dislocation and failure after DSAEK.

Endothelial keratoplasty: from DLEK to DMEK

The last decade has heralded a revolutionary shift in the treatment of corneal endothelial disease. Only 15 years ago, the only surgical treatment for pseudophakic bullous keratopathy and Fuchs dystrophy was penetrating keratoplasty [PK]. Although used successfully for over a century, PK requires many months of refractive adjustments before the eye achieves visual stability. Starting with the advent of posterior lamellar keratoplasty in the late 1990s, a number of procedures have been developed, refined, and widely adopted, which have given patients faster recoveries and improved globe stability in comparison to traditional corneal transplantation. Each iteration of endothelial keratoplasty [EK] has involved the increasingly selective transplantation of corneal endothelial cells. Preliminary results of the most recent form of EK, Descemet's membrane EK, suggest that pure endothelial cell transplantation is on the horizon