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Outcomes After DSEK in 101 Eyes With Previous Trabeculectomy and Tube Shunt Implantation

Aldave, Anthony J. MD; Chen, Judy L.; Zaman, Arman S.; Deng, Sophie X. MD, PhD; Yu, Fei PhD

doi: 10.1097/ICO.0000000000000028
Clinical Science

Purpose: The aim of this study was to determine the outcomes after Descemet stripping endothelial keratoplasty (DSEK) in eyes with previous glaucoma surgery.

Methods: This is a retrospective review of all DSEK procedures performed by 2 surgeons from May 1, 2006, to December 31, 2012.

Results: Four hundred sixty-two DSEK procedures were performed, of which 113 (24%) were performed in 101 eyes after a trabeculectomy (52 procedures) and/or tube shunt implantation (76 procedures) (15 procedures in eyes with both). Primary graft failure and donor dislocation developed in 4.4% and 14.2% of cases in eyes with previous glaucoma surgery, not significantly different from the 3.2% (P = 0.56) and 11.5% (P = 0.51) in eyes without prior glaucoma surgery. During a mean follow-up of 20.7 ± 17.6 months, endothelial rejection developed in a greater percentage of eyes with previous glaucoma surgery (12.9%; 0.069/eye-year) compared with that in eyes without surgery (6.9%; 0.042/eye-year), although the difference was not statistically significant (P = 0.066 for percentage of eyes; P = 0.16 for rejection rate). Secondary graft failure developed in a significantly higher percentage of eyes with previous glaucoma surgery (15.9%; 0.094/eye-year) compared with that in eyes without surgery (3.2%; 0.019/eye-year) (P < 0.0001; P < 0.0001). Elevated intraocular pressure after DSEK was significantly more common in eyes with medically treated glaucoma (41.3%; 0.345/eye year) than in eyes with a previous glaucoma surgery (23.8%; 0.145/eye-year) and without glaucoma (20.0%; 0.138/eye year) (P = 0.009; P = 0.007).

Conclusions: Although intraoperative and early postoperative complications such as donor dislocation and primary graft failure are not significantly more common after DSEK in eyes with previous glaucoma surgery, secondary graft failure is. In contrast, other postoperative complications such as elevated intraocular pressure are significantly more common in eyes with medically treated glaucoma than in eyes with previous glaucoma surgery and without glaucoma.

Jules Stein Eye Institute, David Geffen School of Medicine, The University of California, Los Angeles, CA.

Reprints: Anthony J. Aldave, The Jules Stein Eye Institute, David Geffen School of Medicine, 100 Stein Plaza, UCLA, Los Angeles, CA 90095 (e-mail: aldave@jsei.ucla.edu).

The authors have no funding or conflicts of interest to disclose.

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Received August 14, 2013

Accepted October 07, 2013

© 2014 by Lippincott Williams & Wilkins.