Modified DSAEK successful in patients with glaucoma drainage devices

CHICAGO — Descemet's stripping automated endothelial keratoplasty can be successfully performed in glaucoma patients who have already received a glaucoma drainage device, a presenter said here.

Kamran Riaz

Kamran Riaz, a fourth-year medical student, presented data on six glaucoma patients with drainage devices who underwent DSAEK.

"What we saw was that there were no graft detachments or dislocations in any of the six patients," he said. "The IOP was maintained at therapeutic levels in the postop period, and again, no pressure spikes greater than 21 mm Hg were seen immediately postop."

In addition, Mr. Riaz said visual acuity improved in all patients at the 6-month follow-up appointment.

"What is of interest is that three of our patients developed worsened astigmatism when seen at 6 months postop," he said.

This study included five patients who had prior tube shunt surgery and one who received a concurrent tube shunt and DSAEK. The concurrent case was the only patient to receive a tied tube shunt and experienced loss of vision due to a tube blockage, requiring immediate surgical treatment, Mr. Riaz said.

The procedure was slightly modified both with the tube shunt and the DSAEK technique, he explained.

"The tube shunts were modified to ensure they beveled up and away from the graft, and most of the shunts, four out of six, were placed in the superior temporal quadrant," Mr. Riaz said. "The DSAEK technique that we used in this particular series was modified by filling the anterior chamber with 100% air intraoperatively and attempting to minimize air loss by keeping the patient supine from 1 to 2 hours after surgery."

There was no air removal before discharge, he added.

Corneal edema resolved in five of the six patients, with one patient experiencing excessive intraoperative manipulation of the donor tissue, causing unresolved edema, Mr. Riaz said. He said repeat DSAEK was done at 1 month with good results.

"What this series seems to suggest is that it does not seem necessary to tie or plug the tube. There will be enough air to achieve donor-graft adherence to the recipient's cornea," Mr. Riaz said.