Corneal Graft Survival and Intraocular Pressure Control after Descemet Stripping Automated Endothelial Keratoplasty in Eyes with Pre-existing Glaucoma

PURPOSE: To describe the effect of Descemet stripping automated endothelial keratoplasty (DSAEK) on intraocular pressure (IOP) and corneal graft survival in eyes with pre-existing glaucoma or ocular hypertension. DESIGN: Retrospective, observational case series. METHODS: We performed a retrospective review of 184 eyes that underwent DSAEK from January 2007 through May 2009 at the Singapore National Eye Centre. Eyes with pre-existing glaucoma or ocular hypertension that underwent DSAEK were included, whereas those with a follow-up period of less than 12 months were excluded. Main outcome measures were graft failure and need for additional IOP-lowering treatment after DSAEK. RESULTS: Forty-seven eyes (51% male; mean age, 66.6 years) with glaucoma underwent DSAEK and were followed-up for a mean of 27.3 +/- 8.5 months. Before DSAEK, 60% were taking at least 1 topical IOP-lowering medication, whereas 14 eyes (30%) previously had undergone glaucoma filtration surgery. After DSAEK, visual acuity improved by a mean of 5.4 +/- 3.7 Snellen lines. Seventeen percent of grafts failed at a mean of 12.8 +/- 7.0 months. The mean IOP increased by 2.1 mm Hg to 16.0 +/- 2.5 mm Hg, with 62% requiring additional TOP-lowering treatment and 28% needing filtration surgery at a mean of 9.3 months after DSAEK. Eyes without prior filtration surgery and eyes that underwent additional intraoperative procedures during DSAEK were 10 and 18 times more likely to require IOP-lowering treatment after DSAEK (P = .002 and P = .008), respectively. CONCLUSIONS: With prompt and appropriate intervention, TOP in glaucomatous eyes undergoing DSAEK can be controlled with minimal increase after DSAEK. Eyes with previous filtration surgery require fewer medications to control elevated TOP than eyes that have not had previous surgery. (Am J Ophthalmol 2011;152: 48-54. (C) 2011 by Elsevier Inc. All rights reserved.)