Prior glaucoma surgery did not affect long-term visual outcomes after DSEK

SAN DIEGO — Prior glaucoma surgery correlated with an early postop spike in IOP but did not negatively affect long-term visual outcomes after Descemet's stripping endothelial keratoplasty, according to a study.

Thasarat S. Vajaranant

"For conventional keratoplasty, glaucoma is reported to be a risk factor for poor outcome," Thasarat S. Vajaranant, MD, said at the American Glaucoma Society meeting here.

The retrospective chart review included 400 cases divided into three groups: 315 non-glaucomatous controls, 64 glaucoma patients with no prior glaucoma surgery and 21 glaucoma patients with prior glaucoma surgery.

Primary outcome measures were visual acuity and IOP. Assessments were made at baseline and 1, 3, 6 and 12 months postop.

Data showed that 18 controls required glaucoma medication after DSEK. "This is interesting, since none of these patients used glaucoma medication prior to DSEK," Dr. Vajaranant said.

Glaucoma patients had worse vision after surgery. However, both glaucoma groups showed significant improvement of vision at 12 months and reached visual acuities of 20/40.

All patients showed significant IOP elevation after DSEK; glaucoma patients with prior glaucoma surgery showed the highest elevations. IOP control was achieved in 71% of patients with prior glaucoma surgery at 12 months, Dr. Vajaranant said.

The incidence of elevated IOP after DSEK was comparable to that found after penetrating keratoplasty: 35% in controls and 45% in glaucoma patients in both groups.

Close monitoring of IOP is recommended for glaucoma patients undergoing DSEK, Dr. Vajaranant said.