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Outcomes of Descemet Stripping Automated Endothelial Keratoplasty in Patients With Previous Glaucoma Drainage Device Insertion

Kim, Peter MBBS(Hons), FRANZCO; Amiran, Maoz D MD; Lichtinger, Alejandro MD; Yeung, Sonia N MD, FRCS; Slomovic, Allan R MA, MD, FRCS; Rootman, David S MD, FRCS

doi: 10.1097/ICO.0b013e318224820a
Clinical Science

Purpose: To report the outcomes of Descemet stripping automated endothelial keratoplasty (DSAEK) in patients with a previously inserted glaucoma drainage device (GDD).

Methods: The clinical records of patients who had DSAEK surgery with a history of GDD insertion were reviewed.

Results: Eleven eyes of 10 patients (7 men and 3 women) were included. The mean age for DSAEK surgery was 67.2 ± 20.4 years (range, 22–93 years). The mean follow-up after DSAEK surgery was 20.2 ± 10.7 months (range, 3–37 months). Preoperative mean logarithm of the minimum angle of resolution (logMAR)–corrected distance visual acuity was 1.8 ± 0.6 (range, 20/100 to hand motions), and this improved to 0.9 ± 0.8 (range, 20/40 to hand motions) at the final follow-up (P < 0.01). There was no statistical difference in mean pre-DSAEK versus final post-DSAEK intraocular pressure (P = 0.88). Six of 11 eyes (54.5%) had double GDD insertion before DSAEK surgery. GDD tubes were trimmed in 6 eyes (54.5%), and no eyes required further glaucoma surgical intervention after DSAEK surgery. Postoperative complications included early postoperative graft dislocation in 4 eyes (36.4%) that were successfully repositioned. Four eyes (36.4%) had an episode of endothelial rejection, with 2 patients (18.2%) requiring repeat endothelial keratoplasty for endothelial failure. The mean donor endothelial cell count was 2740 cell per square millimeter preoperatively and reduced to 858 cells per square millimeter at the final follow-up, a significant mean reduction of 69%. This was significantly greater than previously reported endothelial cell loss after DSAEK alone at our institution.

Conclusions: Although surgery may be more challenging, the presence of GDD is not a contraindication to DSAEK surgery. In this series, there was a high rate of dislocation that was successfully managed with rebubbling. DSAEK seems to be a reasonable alternative to penetrating keratoplasty for corneal decompensation after GDD.

From the Department of Ophthalmology, Toronto Western Hospital, University of Toronto, Ontario, Canada.

Received for publication February 14, 2011; revision received April 28, 2011; accepted May 14, 2011.

Supported by the E.A. Baker Fellowship Fund Grant from the Canadian National Institute for the Blind (S.N.Y.).

M. D. Amiran is a recipient of the Schwartz Reisman Fellowship, Toronto, Canada, for 2010–2011.

The authors state that they have no conflicts of interest to disclose.

Reprints: Dr Peter Kim, Department of Ophthalmology, Toronto Western Hospital, Toronto, Ontario, Canada M5T 2S8 (e-mail:

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