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Glaucoma Progression after Descemet’s Stripping Endothelial Keratoplasty. Neelofar Ghaznawi MD, Melissa B Daluvoy MD, Ajoy Virdi MD, Edwin S Chen, Kristin M Hammersmith MD, Christopher J Rapuano MD. The authors have no financial interest in the subject matter of this presentation. - PowerPoint PPT Presentation
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Glaucoma Progression after Glaucoma Progression after Descemet’s Stripping Endothelial Descemet’s Stripping Endothelial
KeratoplastyKeratoplasty
Neelofar Ghaznawi MD, Melissa B Daluvoy MD, Ajoy Virdi MD, Edwin S Chen, Kristin M Hammersmith MD,
Christopher J Rapuano MD
The authors have no financial interest in the subject matter of this presentation
Descemet’s Stripping Endothelial Descemet’s Stripping Endothelial Keratoplasty Keratoplasty
DSEK provides rapid healing, predictable DSEK provides rapid healing, predictable refractive outcomes, and tectonic stability.refractive outcomes, and tectonic stability.
Evolution of DSEK technique has resulted Evolution of DSEK technique has resulted in better visual outcomes and fewer post-in better visual outcomes and fewer post-operative complications.operative complications.
DSEK has become the preferred treatment DSEK has become the preferred treatment for any endothelial dysfunction.for any endothelial dysfunction.
Purpose and DesignPurpose and DesignPurposePurpose1)1) To characterize the pattern of glaucoma progression after Descemet’s To characterize the pattern of glaucoma progression after Descemet’s
stripping endothelial keratoplasty in patients without preexisting glaucoma stripping endothelial keratoplasty in patients without preexisting glaucoma and in those with preexisting glaucoma with and without prior glaucoma and in those with preexisting glaucoma with and without prior glaucoma surgerysurgery
2)2) To compare visual outcomes among the 3 groupsTo compare visual outcomes among the 3 groups
51 DSAEK
22 Glaucoma 29 Control
12 Surgical 10 Medical
Outcome MeasuresVisual AcuityIOPSteroid doseIOP lowering medicationsRejectionGlaucoma procedures
•Preexisting glaucoma was defined as any of the following: documented history of glaucoma, preoperative use of anti glaucomatous medications and preoperative IOP >24, of C/D > 0.6.•Post operative IOP increase was defined as any initiation or increase in anti glaucomatous medications or IOP > 25 or a relative increase in IOP >10 mmHg above baseline
Demographics/ Baseline Characteristics
Controls (29 eyes)
Glaucoma(Medical)( 10 eyes)
Glaucoma(Surgical) (12 eyes) p values
OD:OS 16:13 7:3 5:7 0.550.55
% Caucasian 89% 100% 86% 0.070.07
% Fuchs' Endothelial Dystrophy 77% 30% 29% ..00010001
Preoperative VA (median [min, max]) 20/100 (20/25, CF)20/100 (20/25, CF) 20/400 (20/50, CF)20/400 (20/50, CF) 20/400 (20/100, CF)20/400 (20/100, CF) .003.003
Preoperative IOP (mmHg, median [min, max] 13 (8,22) 15 (12,18) 11 (5,17) .013.013
Cup-to- disc ratio 0.30 (0.2-0.65) 0.49 (0.2-0.6) 0.65 (0.35-0.9) .0001.0001
Summary of Demographics and Baseline Characteristics
21%
50%
42%
0%
10%
20%
30%
40%
50%
Perc
enta
ge o
f Pa
tient
s
Control
Glaucoma
Glaucoma Surgery
Results
0%
50%
17%5%
50%
13%
0%
10%
20%
30%
40%
50%
Perc
enta
ge o
f pat
ient
s
6 months 1 year
Control
Glaucoma
Glaucoma Surgery
13%
50%
10%
29%
67%
50%
0%
10%
20%
30%
40%
50%
60%
70%
Perc
enta
ge o
f Pat
ient
s
6 months 1 year
Control
Glaucoma
Glaucoma Surgery
p< .05 p< .05
p< .05
2 Glaucoma
Procedures
2 Surgical
0 Medical
0 Control
Initiation or Increase in Glaucoma MedicationsIncidence of IOP Elevation
Use of a Less Potent Steroid
Percentage of Control Eyes With Elevated Percentage of Control Eyes With Elevated IOPIOP
1 2 3 4 5 6 7 8 9 10 11 12
0%
2%
4%
6%
8%
10%
12%
14%
16%
Percentage of eyes
Postop (months)
Final Visual Outcomes in SubgroupsFinal Visual Outcomes in Subgroups
VA Median(min, max)
Without PreexistingGlaucoma
N=29
With PreexistingGlaucoma
N=10
With Prior Glaucoma Surgeries
N=12
P Value
Preoperative 20/100 (20/25, CF) 20/400 (20/50, CF) 20/400 (20/100, CF) 0.003
1 year 20/40 (20/25, 20/400) 20/50 (20/40, 20/70) 20/60 (20/25, 20/400) 0.112
Median lines ofimprovement 5.3 5.5 5.2 0.979
1 year compared to baseline P< 0.0001 P< 0.0001 P< 0.0001
Conclusions Conclusions Incidence of elevated IOP after DSEK:Incidence of elevated IOP after DSEK:
Without preexisting glaucoma: 21%Without preexisting glaucoma: 21%With glaucoma and no h/o surgery: 50%With glaucoma and no h/o surgery: 50%With glaucoma and prior surgery: 42%With glaucoma and prior surgery: 42%
At 1 year follow up glaucoma medication added in:At 1 year follow up glaucoma medication added in:5 % of patients without glaucoma5 % of patients without glaucoma 50 % of patients with medically managed glaucoma 50 % of patients with medically managed glaucoma 13% of patients with prior glaucoma surgery13% of patients with prior glaucoma surgery
At 1 year 17% of patients with prior surgery required an At 1 year 17% of patients with prior surgery required an additional glaucoma drainage procedure. additional glaucoma drainage procedure.
All groups gained statistically significant improvement in VA All groups gained statistically significant improvement in VA at 12 months compared with baselineat 12 months compared with baseline
ConclusionsConclusions
Given high incidence of post operative IOP Given high incidence of post operative IOP elevation, close monitoring of IOP is elevation, close monitoring of IOP is warranted.warranted.
Preexisting glaucoma does not negatively Preexisting glaucoma does not negatively affect improvement of VA after DSEK.affect improvement of VA after DSEK.
ReferencesReferences
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