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In certain cases, DSEK succeeds when combined with glaucoma, cataract procedures

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ATLANTA — Descemet's stripping endothelial keratoplasty offers several advantages over penetrating keratoplasty, even in cataract and glaucoma cases, a surgeon said here.

W. Barry Lee

Special considerations need to be made when dealing with combined DSEK and cataract or glaucoma cases to enhance results, W. Barry Lee, MD, said at Cornea Subspecialty Day preceding the American Academy of Ophthalmology meeting.

In DSEK combined with glaucoma procedures, Dr. Lee said physicians need to temporarily obstruct the tube shunt, inject air with a 30 g needle rather than a cannula and provide an airtight seal through suturing the paracentesis and wound.

For cataract procedures, Dr. Lee said, "Trypan blue can be really advantageous. ... It certainly can help you visualize the anterior capsule for your rhexis." He also advised using cohesive elastic in these procedures.

A potential for higher rates of tissue dislocation and second procedures exists in glaucoma patients, thus patients should be appropriately informed and educated before surgery, he said. DSEK remains safe and effective despite cataracts and glaucoma, although prediction of vision return should be guarded in severe glaucoma cases, he said.