Descemet stripping with automated endothelial keratoplasty: a comparative study of outcome in patients with preexisting glaucoma

To compare postoperative complications after Descemet stripping with automated endothelial keratoplasty [DSAEK] in patients with and without glaucoma. For this retrospective study a series of 298 DSAEK cases performed at the Doheny Eye Institute were taken, we compared postoperative complications in eyes with glaucoma on medication [55] or with previous glaucoma surgeries [64] with a time-matched group of all other DSAEK cases [179, control]. With a mean follow-up of 1.85 +/- 1.12 years, the complication rates were 12.8%, 11.1%, and 26.8% for postoperative graft detachment, graft failure, and IOP elevation, respectively. Graft detachment was an independent risk factor for graft failure [odds ratio OR = 12.35, 95% confidence interval CI [5.46-27.90], P < 0.001]. Graft detachment was not associated with either history of glaucoma or glaucoma surgery [P > 0.05]. Glaucoma on medication had no increased risks of graft failure compared to normal eyes [P = 0.38]. However, increased risk of failure was seen in eyes with prior incisional glaucoma surgeries [OR = 4.26, 95% CI [1.87-9.71], P < 0.001]. Medically managed glaucoma has increased risks of postoperative IOP elevation [OR = 2.39, 95% CI [1.25-4.57], P = 0.013], whereas surgically managed glaucoma has no significant elevation [P = 0.23]. Elevation of IOP was not significantly correlated with graft failure [P = 0.21]. DSAEK is the preferred treatment for corneal endothelial dystrophy. We observed that having glaucoma or glaucoma surgery is not associated with graft detachment. A history of glaucoma surgery and postoperative graft detachment appeared to be important risk factors for graft failure. And more studies are indicated to study long-term IOP evolution in post-DSAEK patients and its association with graft survival

Long term comparison between single stage Baerveldt and Ahmed glaucoma implants in pediatric glaucoma

To compare the long term intraocular pressure control in pediatric glaucoma patients who underwent single stage Baerveldt glaucoma valve and Ahmed glaucoma valve S2 implantation. A retrospective study was conducted to analyze the data of patients with single stage Baerveldt glaucoma valve and Ahmed valve implantation at Children Hospital Los Angeles. Medical records of patients were reviewed retrospectively and divided into two groups. All cases received single stage valve implantation in which the tube was inserted primarily into the anterior chamber. In cases with Baerveldt implants, the silicone tube was ligated near its plate location with a single absorbable suture. Group 1 included patients with Baerveldt glaucoma implant model BG 101-350, while group 2 included patients with Ahmed valve implant model S-2. Patients' data collected ranged over the period from 2001 to 2008. The minimum follow up period was 6 month; maximum follow up period was 8 years. All patients were below 18 years of age. Success was considered if last postoperative IOP was between 8 and 24 mm Hg [with or without medications], no additional glaucoma surgery after valve implantation, and absence of visually significant complications. Group 1 included 20 cases and group 2 included 11 cases. Long term success rate based on criterion defined was 80% for group 1 [Baerveldt] with average IOP postoperatively on last follow-up of 19.6 mm Hg. In group 2 [Ahmed], average postoperative pressure was 24 mm Hg with 6 out of 11 considered successful based on criterion giving 54.5% success rate. Conclusion: In the long term, single stage Baerveldt implantation appears to control pressure well in pediatric glaucoma