Glaucoma, non-glaucoma patients who underwent DSEK had similar high IOP, visual outcomes

ATLANTA — There were similar positive outcomes in visual acuity for glaucoma and non-glaucoma patients after Descemet's stripping endothelial keratoplasty, but because of high IOP in both groups, postoperative pressure should be carefully monitored.

Thasarat S. Vajaranant, MD, presented results at the American Academy of Ophthalmology meeting of a retrospective review of visual acuity and IOP in 315 control eyes and 85 glaucoma eyes after DSEK.

"After DSEK, history of pre-existing glaucoma did not appear to be associated with poor outcomes," she said.

Dr. Vajaranant and colleagues found that the incidence of elevated IOP after DSEK was high in both control eyes (37%) and glaucoma eyes (51%). However, this did not appear to affect visual outcomes. The mean visual acuity improvement at 12 months was two lines in the control group and three lines in the glaucoma group, she said.

Dr. Vajaranant's presentation was awarded the best paper of the glaucoma original papers session.

Descemet’s stripping lamellar endokeratoplasty is now the procedure of choice for corneal endothelial dysfunction. It is important to determine this procedure’s effect on pre-existing glaucoma and, conversely, the effect of elevated IOP on the outcome of DSEK. Of interest, both the glaucoma and control groups had a significant incidence of elevated IOP after DSEK with a 32% and 18% use of postop glaucoma meds in the glaucoma vs. control group, respectively. Also of interest was the relative similarity of the penetrating keratoplasty literature with this study in DSEK patients regarding elevated IOP in glaucoma patients and nonglaucoma patients. The author postulates that the major cause of IOP elevation in both groups is from steroid response; however, the success of DSEK seems to be less effected by IOP elevation than PK based on the results of this study.

– Steven R. Sarkisian Jr., MD
Dean A. McGee Eye Institute, Oklahoma City