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

Pho Nguyen, Shabnam Khashabi, Vikas Chopra, Brian Francis, Martin Heur, Jonathan C. Song, Samuel Chi-Hung Yiu

Research output: Contribution to journalArticle

Abstract

Purpose: To compare postoperative complications after Descemet stripping with automated endothelial keratoplasty (DSAEK) in patients with and without glaucoma. Methods: 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). Results: 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). Conclusion: 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.

Original languageEnglish (US)
Pages (from-to)73-78
Number of pages6
JournalSaudi Journal of Ophthalmology
Volume27
Issue number2
DOIs
StatePublished - Apr 2013

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Corneal Transplantation
Glaucoma
Outcome Assessment (Health Care)
Transplants
Graft Survival
Research Design
Retrospective Studies
Odds Ratio
Confidence Intervals

Keywords

  • Cornea transplant
  • Drainage device
  • DSAEK
  • Glaucoma
  • Graft failure
  • Intraocular pressure
  • Trabeculoplasty
  • Tube shunt

ASJC Scopus subject areas

  • Ophthalmology

Cite this

Descemet stripping with automated endothelial keratoplasty : A comparative study of outcome in patients with preexisting glaucoma. / Nguyen, Pho; Khashabi, Shabnam; Chopra, Vikas; Francis, Brian; Heur, Martin; Song, Jonathan C.; Yiu, Samuel Chi-Hung.

In: Saudi Journal of Ophthalmology, Vol. 27, No. 2, 04.2013, p. 73-78.

Research output: Contribution to journalArticle

Nguyen, Pho ; Khashabi, Shabnam ; Chopra, Vikas ; Francis, Brian ; Heur, Martin ; Song, Jonathan C. ; Yiu, Samuel Chi-Hung. / Descemet stripping with automated endothelial keratoplasty : A comparative study of outcome in patients with preexisting glaucoma. In: Saudi Journal of Ophthalmology. 2013 ; Vol. 27, No. 2. pp. 73-78.
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abstract = "Purpose: To compare postoperative complications after Descemet stripping with automated endothelial keratoplasty (DSAEK) in patients with and without glaucoma. Methods: 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). Results: 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). Conclusion: 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.",
keywords = "Cornea transplant, Drainage device, DSAEK, Glaucoma, Graft failure, Intraocular pressure, Trabeculoplasty, Tube shunt",
author = "Pho Nguyen and Shabnam Khashabi and Vikas Chopra and Brian Francis and Martin Heur and Song, {Jonathan C.} and Yiu, {Samuel Chi-Hung}",
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T2 - A comparative study of outcome in patients with preexisting glaucoma

AU - Nguyen, Pho

AU - Khashabi, Shabnam

AU - Chopra, Vikas

AU - Francis, Brian

AU - Heur, Martin

AU - Song, Jonathan C.

AU - Yiu, Samuel Chi-Hung

PY - 2013/4

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N2 - Purpose: To compare postoperative complications after Descemet stripping with automated endothelial keratoplasty (DSAEK) in patients with and without glaucoma. Methods: 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). Results: 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). Conclusion: 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.

AB - Purpose: To compare postoperative complications after Descemet stripping with automated endothelial keratoplasty (DSAEK) in patients with and without glaucoma. Methods: 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). Results: 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). Conclusion: 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.

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KW - DSAEK

KW - Glaucoma

KW - Graft failure

KW - Intraocular pressure

KW - Trabeculoplasty

KW - Tube shunt

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