Early results of descemet-stripping and automated endothelial keratoplasty (DSAEK) in patients with glaucoma drainage devices

PURPOSE: To evaluate the outcome of Descemet-stripping and automated endothelial keratoplasty (DSAEK) in patients with glaucoma tube shunts in the anterior chamber. METHODS: Retrospective review of 4 patients with a history of tube shunt placement that experienced corneal decompensation and subsequently underwent DSAEK at 1 institution. Details of the surgical procedures as well as postoperative features including graft attachment, visual acuity, intraocular pressure (IOP), graft clarity, and central corneal thickness were recorded. RESULTS: There were no graft detachments postoperatively. In all but 1 case, the corneal edema resolved with a corresponding decrease in corneal thickness. In 1 case, where there was excessive donor tissue manipulation intraoperatively, the edema failed to resolve. This patient underwent a repeat DSAEK with subsequent graft attachment and resolution of the corneal edema. In all 4 patients, the tube shunt was revised at the time of DSAEK. The tube was not tied or plugged in any of the patients. Except for 1 patient with fibrin reaction, there were no IOP spikes postoperatively. At the 6-month follow-up, the visual acuity had improved in all patients and the IOP had not changed significantly from preoperative levels. CONCLUSION: This small series suggests that DSAEK is a viable and effective option in patients with existing tube shunts. The presence of a tube did not affect the rate of graft dislocation; however, it appeared to increased the rate of complications postoperatively. These early outcomes support the use of DSAEK as an alternative to penetrating keratoplasty in this patient population.