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

ABSTRACT

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