Transcript Slide 1

Prior incisional glaucoma surgery increases
graft failure and dislocation in eyes undergoing
Descemet’s stripping automated endothelial
keratoplasty (DSAEK).
Francis Char DeCroos, MD
Derek W. DelMonte, MD
Jessica H. Chow, MD
Terry Kim, MD
Alan N. Carlson, MD
Natalie A. Afshari, MD
Duke Eye Center
The authors have no financial interest in the subject
matter of this poster.
Purpose
• To investigate the relationship between prior
incisional glaucoma surgery and the rates of
DSAEK graft dislocation and failure.
• Has not been previously examined in a large
series
Hypothesis
• Challenges in glaucomatous eyes
–
–
–
–
Increased rate of PAS1
Increased rate of narrow angles or shallow AC2
Difficulty in obtaining appropriate AC air fill3
Manipulation with indwelling shunt
– 1.8X chance of increased rejection4
1. Lee, Kor J Ophthalmol, 2006. 2. Bonomi, Ophthalmol, 2000;3. Ide, Open
Ophthal J, 2009; 4. Price, Br J Ophthalmol, 2009.
4 Indwelling Glaucoma Tubes
Post Operative Appearance
DSAEK
Please select “view additional images/video” for
surgical video.
Air Escape Into Trab During DSAEK Air Fill
Courtesy of Dr. Alan N. Carlson, Duke Eye Center
Methods
• Retrospective case-control study
• Cases: Prior diagnosis of glaucoma
– No history of incisional glaucoma surgery
– Prior trabeculectomy and/or aqueous shunt(s)
• Controls: No prior diagnosis of glaucoma
• Include only first DSAEK in any eye
Patient Demographics
Control
Patients
RACE
Total
96
424
328
Control
Glaucoma
69.2 ± 11.3
70.79 ± 17.7
Male
114
44
Female
214
52
White
275
71
Black
28
20
Other
25
5
AGE
SEX
Glaucoma
Pre-Operative
BCVA (logMar)
IOP
Pachymetry
Glaucoma
Control
P-Value
1.46 ± 0.84
0.66 ± 0.54
<0.0001
15.2 ± 5.9
14.9 ± 3.7
0.60
701.7
660.7
0.046
BCVA
*p<0.05 at all evaluated time points
Glaucoma Subgroup Analysis
Glaucoma
n = 96
No Prior Incisional
Surgery
n = 37
Incisional Surgery
n= 59
Trab
n = 20
Tube
n = 27
Trab+Tube
n = 12
Multi-Tube
n = 10
DSAEK Dislocation Rates
Glaucoma
Control
P-Value
Odds Ratio
Dx Glaucoma
10.4%
2.7%
0.0034
4.1
No Prior
Surgery
2.7%
2.7%
1.00
0.98
Prior Surgery
15.3%
2.7%
0.0001
7.23
Multi -Tube
30.0%
2.7%
0.0035
15.19
DSAEK Failure Rates
Glaucoma
Control
P-Value
Odds Ratio
Dx Glaucoma
15.6%
3.0%
0.0003
5.9
No Prior
Surgery
8.1%
3.0%
0.135
2.80
Prior Surgery
20.3%
3.0%
<0.0001
10.84
Multi -Tube
20.0%
3.0%
0.0044
7.95
Conclusions
• Prior Glaucoma Surgery
– Risk factor for graft dislocation
– Risk factor for graft failure
• Indwelling multiple tubes
– Increased risk for graft failure and dislocation