Descemets Stripping Endothelial Keratoplasty after Glaucoma Surgery

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Descemets Stripping Endothelial Keratoplasty
after Glaucoma Surgery

• Adam Easterling, M.D.
• Alan Carlson, M.D.
• Duke University Eye Center
• ASCRS Meeting 2007

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DSEK after Glaucoma Surgery

• Safe?
• Effective?

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Potential Problems with DSEK after Glaucoma
Surgery

• Donor adherence - air leaving the AC
• Trabeculectomy/tube failure - IOP
• Graft failure

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DSEK Postops

• Bubble partially escapes day 1 through
  functioning trab

• Tube patient with previous failed PK clear after
  DSEK

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Our Study

• Retrospective chart review of first 51 patients
  to have DSEK at DUEC with at least one month of
  follow-up
• Two groups
• 1) 39 patients with no previous history of
  invasive glaucoma surgery
• 2) 12 patients with a trabeculectomy or glaucoma
  drainage device (2 trabs, 10 tubes)

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Surgery

• All patients had similar surgery with a sutured
  limbal wound
• Approximately 50 air fill in anterior chamber at
  the end of the case to promote donor adherence
• Controls lie supine for 60 minutes
• Group 2 lie supine for 60-90 minutes

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Outcome Measures

• Preoperative and postoperative IOP
• Number of glaucoma medications used
  preoperatively and postoperatively
• Graft dislocation

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Intraocular Pressure Control
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Glaucoma Medications
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Graft dislocation

• Defined as need for injection of air into the AC
  and/or a repeat graft for poor donor adherence

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Discussion

• With regards to IOP control and donor adherence,
  DSEK appears to be a safe procedure after
  glaucoma surgery with no significant increase in
  the number of glaucoma drops needed
• 60-90 minute supine positioning is effective at
  promoting donor adherence
• Graft dislocation is likely related to surgeon
  experience1, not to previous glaucoma surgery
• 1. Price, et al. JCRS 2006 March 32411-418

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Tube/Trab patient with corneal decompensation?Co
nsider DSEK

• Thanks to
• Terry Kim, M.D.
• Natalie Afshari, M.D.
• Felix Chau, M.D.
• Sandra Stinnett, DrPH