Descemet Stripping Automated Endothelial Keratoplasty in Eyes With Previous Trabeculectomy and Tube Shunt Procedures: Intraoperative and Early Postoperative Complications

• Published in: Cornea Vol. 29; no. 5; pp. 534 - 540
• Main Authors: Phillips, Paul M, Terry, Mark A, Shamie, Neda, Chen, Edwin S, Hoar, Karen, Dhoot, Dilsher, Shah, Anand K, Friend, Daniel J, Rao, Naveen K, Davis-Boozer, David D
• Format: Journal Article
• Language: English
• Published: United States Lippincott Williams & Wilkins, Inc 01-05-2010
• Subjects: Corneal Edema - surgery; Descemet Stripping Endothelial Keratoplasty; Fuchs' Endothelial Dystrophy - surgery; Glaucoma - surgery; Glaucoma Drainage Implants; Humans; Intraocular Pressure; Intraoperative Complications; Postoperative Complications; Retrospective Studies; Risk Factors; Trabeculectomy; Treatment Outcome
• ISSN: 0277-3740; 1536-4798
• DOI: 10.1097/ICO.0b013e3181c11bf3

PURPOSE:To evaluate the intraoperative and early postoperative outcomes of Descemet stripping automated endothelial keratoplasty (DSAEK) in patients with previous glaucoma filtering surgeries.
METHODS:A retrospective review of all DSAEK surgeries performed at one center comparing complications of DSAEK in eyes with previous glaucoma filtering procedures (study eyes) with a time-matched group of all other DSAEK cases (control eyes).
RESULTS:There were 28 study eyes, 19 with previous trabeculectomies and 9 with previous glaucoma drainage devices (GDDs) and 431 control eyes. Study group intraoperative complications included 1 compromised bleb and 1 loss of donor tissue because of traumatic manipulation. One intraoperative complication, a perforation of the donor tissue, occurred in the control group. Venting stab incisions were used more often in study eyes (n = 5; 18%) than in control eyes (n = 12; 4.4%) (P = 0.002). GDD tubes were trimmed in 2 eyes (22%). No intraoperative manipulations were used to occlude the glaucoma filters or tubes. Postoperative complications in the study group included 1 dislocation (3.6%) and 1 decentered graft (3.6%) and 1 eye with loss of pressure control (3.6%), whereas in the control group, there were 10 dislocations (2.3%) and 1 decentered graft (0.2%) (P = 0.267 for dislocations and P = 0.118 for decentered grafts). One episode of pupillary block (0.2%) occurred in the control group, and none occurred in the study group. No primary graft failures occurred in either group.
CONCLUSIONS:DSAEK surgeries in eyes with previous glaucoma filtering procedures were performed without primary graft failure and with reasonably low dislocation (3.6%) and graft decentration (3.6%) rates. Although the intraoperative complication rate for the study group (7.1%) was higher than the rate for the control group (0.23%), excellent early postoperative outcomes can be achieved when DSAEK is performed in eyes with previous trabeculectomies and GDDs.