title: Early results of Descemet-stripping and automated endothelial keratoplasty (DSAEK) in patients with glaucoma drainage devices.
abstract: OBJECTIVE
  To evaluate the outcome of Descemet-stripping and automated endothelial keratoplasty (DSAEK) in patients with glaucoma tube shunts in the anterior chamber.
  
  
  METHODS
  Retrospective review of 4 patients with a history of tube shunt placement that experienced corneal decompensation and subsequently underwent DSAEK at 1 institution. Details of the surgical procedures as well as postoperative features including graft attachment, visual acuity, intraocular pressure (IOP), graft clarity, and central corneal thickness were recorded.
  
  
  RESULTS
  There were no graft detachments postoperatively. In all but 1 case, the corneal edema resolved with a corresponding decrease in corneal thickness. In 1 case, where there was excessive donor tissue manipulation intraoperatively, the edema failed to resolve. This patient underwent a repeat DSAEK with subsequent graft attachment and resolution of the corneal edema. In all 4 patients, the tube shunt was revised at the time of DSAEK. The tube was not tied or plugged in any of the patients. Except for 1 patient with fibrin reaction, there were no IOP spikes postoperatively. At the 6-month follow-up, the visual acuity had improved in all patients and the IOP had not changed significantly from preoperative levels.
  
  
  CONCLUSIONS
  This small series suggests that DSAEK is a viable and effective option in patients with existing tube shunts. The presence of a tube did not affect the rate of graft dislocation; however, it appeared to increased the rate of complications postoperatively. These early outcomes support the use of DSAEK as an alternative to penetrating keratoplasty in this patient population.
authors.affiliation: Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, Chicago, IL 60612, USA.
authors.forename: Kamran M
authors.initials: KM
authors.lastname: Riaz
authors.forename: Joel
authors.initials: J
authors.lastname: Sugar
authors.forename: Elmer Y
authors.initials: EY
authors.lastname: Tu
authors.forename: Deepak P
authors.initials: DP
authors.lastname: Edward
authors.forename: Jacob T
authors.initials: JT
authors.lastname: Wilensky
authors.forename: Abed
authors.initials: A
authors.lastname: Namavari
authors.forename: Ali R
authors.initials: AR
authors.lastname: Djalilian
mesh_terms: D002452:Cell Count; D003316:Corneal Diseases / Q000503:physiopathology / Q000601:surgery; D057111:Descemet Stripping Endothelial Keratoplasty; D004728:Endothelium, Corneal / Q000473:pathology; D005260:Female; D005901:Glaucoma / Q000503:physiopathology / Q000601:surgery; D020327:Glaucoma Drainage Implants; D006801:Humans; D007429:Intraocular Pressure / Q000502:physiology; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D011379:Prognosis; D012189:Retrospective Studies; D014792:Visual Acuity / Q000502:physiology