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DSEK graft survival rates associated with type of prior glaucoma treatment
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Five-year graft survival rates after Descemet’s stripping endothelial keratoplasty were higher among patients with medically managed vs. surgically managed glaucoma, according to a study.
“The findings of this study suggest that the long-term DSEK graft survival in eyes with pre-existing glaucoma is dependent on the type of glaucoma management and the occurrence of a rejection episode after corneal transplantation,” the study authors said.
The retrospective case control study included 453 eyes that underwent DSEK and had at least 1 year of follow-up; 438 eyes had no pre-existing glaucoma, 65 eyes had medically managed glaucoma, and 46 eyes had surgically managed glaucoma.
Graft failure was defined as persistent corneal edema resulting in permanent loss of optical clarity. Investigators used univariate and multivariate analysis to evaluate nine potential risk factors for graft failure. Outcome measures also included endothelial survival rate. Mean follow-up was 4 years.
Study results showed endothelial failure in 32 grafts (7%).
Five-year graft survival rates were 96% in the group without pre-existing glaucoma, 90% in the medically managed glaucoma group and 48% in the surgically managed glaucoma group. The between-group difference was statistically significant (P < .001).
Graft survival was significantly diminished in eyes with prior trabeculectomy only and in eyes with a prior glaucoma drainage device (P < .0001). In the surgically managed glaucoma group, the 5-year survival rate was 25% in eyes with a glaucoma drainage device and 59% in eyes with previous trabeculectomy.
Prior glaucoma surgery (P < .0001) and occurrence of a rejection episode (P = .0079) were most strongly associated with endothelial failure after DSEK.
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