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Clinical Outcomes of Descemet Stripping Endothelial Keratoplasty in Eyes With Glaucoma Drainage Devices

Kang, Joann J. MD*; Ritterband, David C. MD; Atallah, Richard T. MS; Liebmann, Jeffrey M. MD§; Seedor, John A. MD

doi: 10.1097/IJG.0000000000001272
Original Studies

Precis: In this retrospective case series of 85 eyes, 31.8% developed graft failure and graft survival was 50% at 3 years. The presence of an aqueous shunt has a significantly adverse effect on long-term graft survival.

Purpose: To report visual outcomes and complications of Descemet stripping endothelial keratoplasty (DSEK) in eyes with glaucoma drainage devices (GDD).

Materials and Methods: A retrospective chart review was conducted of 122 procedures of 85 eyes of 83 patients who underwent DSEK and had prior or concurrent GDD implantation. Mean follow-up was 36.5±31.4 months. Patients with postoperative follow-up of <3 months were excluded from analysis. Outcome measures examined included visual acuity, donor dislocation rate, intraocular pressure (IOP), and graft survival.

Results: The mean logMAR vision improved to 1.07 postoperatively from 1.43 preoperatively, with 61% of eyes experiencing improved visual acuity. Graft dislocation occurred in 27 (31.8%) eyes and required repeat injection of air in the anterior chamber. Primary graft failure occurred in 2 (2.4%) eyes, whereas secondary graft failure occurred in 27 (31.8%) of eyes, with an average time of 24.3 months for development. Estimated survival rates at 1, 2, and 3 years were 89%, 78%, and 50%, respectively. Escalation of IOP occurred in 21 (24.7%) eyes postoperatively, where 14 eyes underwent medical therapy and 7 eyes required surgical intervention/laser for IOP control.

Conclusions: DSEK after GDD is a viable alternative to treat endothelial dysfunction, with the majority of patients achieving visual improvement. However, aqueous shunt implantation has a significantly adverse effect on long-term graft survival and close follow-up is warranted.

*Ophthalmology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx

Ophthalmology, New York Eye and Ear Infirmary, Mt. Sinai School of Medicine

§Edward S. Harkness Eye Institute, Columbia University Irving Medical Center, New York, NY

Rutgers New Jersey Medical School, Newark, NJ

Disclosure: The authors declare no conflict of interest.

Reprints: Joann J. Kang, MD, Department of Ophthalmology and Visual Sciences, Montefiore Medical Center, Albert Einstein College of Medicine, 3332 Rochambeau Avenue, Bronx, NY 10467 (e-mail:

Received December 20, 2018

Accepted April 10, 2019

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