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Glaucoma Progression after Descemet’s Stripping Endothelial Keratoplasty

Glaucoma Progression after Descemet’s Stripping Endothelial Keratoplasty. Neelofar Ghaznawi MD, Melissa B Daluvoy MD, Ajoy Virdi MD, Edwin S Chen, Kristin M Hammersmith MD, Christopher J Rapuano MD. The authors have no financial interest in the subject matter of this presentation.

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Glaucoma Progression after Descemet’s Stripping Endothelial Keratoplasty

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  1. Glaucoma Progression after Descemet’s Stripping Endothelial Keratoplasty Neelofar Ghaznawi MD, Melissa B Daluvoy MD, Ajoy Virdi MD, Edwin S Chen, Kristin M Hammersmith MD, Christopher J Rapuano MD The authors have no financial interest in the subject matter of this presentation

  2. Descemet’s Stripping Endothelial Keratoplasty • DSEK provides rapid healing, predictable refractive outcomes, and tectonic stability. • Evolution of DSEK technique has resulted in better visual outcomes and fewer post-operative complications. • DSEK has become the preferred treatment for any endothelial dysfunction.

  3. 51 DSAEK 22 Glaucoma 29 Control 12 Surgical 10 Medical Purpose and Design Purpose • To characterize the pattern of glaucoma progression after Descemet’s stripping endothelial keratoplasty in patients without preexisting glaucoma and in those with preexisting glaucoma with and without prior glaucoma surgery • To compare visual outcomes among the 3 groups Outcome Measures Visual Acuity IOP Steroid dose IOP lowering medications Rejection Glaucoma procedures • Preexisting glaucoma was defined as any of the following: documented history of glaucoma, preoperative use of anti glaucomatous medications and preoperative IOP >24, of C/D > 0.6. • Post operative IOP increase was defined as any initiation or increase in anti glaucomatous medications or IOP > 25 or a relative increase in IOP >10 mmHg above baseline

  4. Summary of Demographics and Baseline Characteristics

  5. 2 Glaucoma Procedures 2 Surgical 0 Control 0 Medical Results Initiation or Increase in Glaucoma Medications Incidence of IOP Elevation p< .05 p< .05 Use of a Less Potent Steroid p< .05

  6. Percentage of Control Eyes With Elevated IOP

  7. Final Visual Outcomes in Subgroups

  8. Conclusions Incidence of elevated IOP after DSEK: • Without preexisting glaucoma: 21% • With glaucoma and no h/o surgery: 50% • With glaucoma and prior surgery: 42% At 1 year follow up glaucoma medication added in: • 5 % of patients without glaucoma • 50 % of patients with medically managed glaucoma • 13% of patients with prior glaucoma surgery At 1 year 17% of patients with prior surgery required an additional glaucoma drainage procedure. All groups gained statistically significant improvement in VA at 12 months compared with baseline

  9. Conclusions • Given high incidence of post operative IOP elevation, close monitoring of IOP is warranted. • Preexisting glaucoma does not negatively affect improvement of VA after DSEK.

  10. References • Chien AM, Schmidt CM, Cohen EJ. Glaucoma in the immediate postoperative period after penetrating keratoplasty. Am J Ophthalmol. 1193:115:711-714 • Goldber DB, Schanzlin DJ, Brown SI. Incidence of increased intraocular pressure after keratoplasty. Am J Ophthalmol 1981:92:372-7. • Williams KA, Roder D, Esterman A, Muehlberg SM, Coster DL. Factors predictive of corneal graft survival; report from the Australian Corneal Graft Registry. Ophthalmology 1992; 99: 403 414 • Suh LH, Yoo, SH, Deobhakta A, Donaldson KE, Alfonso EC, Culbertson WW, O’Brien TP. Complication of descemet’s stripping with automated endothelial keratoplasty: Survey of 118 at one institute. Ophthalmology; 2008; 115:1517-1724 • Terry MA. Endothelial keratoplasty: A simplified technique to minimize graft dislocation, iatrogenic graft failure, and pupillary block. Ophthalmology. 2008; 115:1179-1186 • Terry MA. Histology of dislocations in endothelial keratoplasty (DSEK and DLEK): A laboratory-based, surgical solution to dislocation in 100 consecutive DSEK cases. Cornea. 2006; 25: 926-932 • Terry MA. Endothelial keratoplasty: The influence of preoperative donor endothelial cell densities on dislocation, primary graft failure, and 1 year cell counts. Cornea 2008; 27:1131-1137 • Vajaranant TS, Price, MO, Price WP. Visual acuity and IOP after DSEK in eyes with and without glaucoma. Ophthalmology; 116:1644-1650 • Price MO, Price FW Jr, Trespalacios R. Endothelial keratoplasty of aniridic aphakic eyes. J Cataract Refract Surg 2007; 33:376-379 • Wylegala E, Tarnawska D. Management of pseudophakic bullous keratopathy by combined Descemet-stripping endothelial keratoplasty and intraocular lens exchange. J Cataract Refract Surg; 2008; 34:1708-1714

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