title: Outcomes of Descemet stripping automated endothelial keratoplasty in patients with previous glaucoma drainage device insertion.
abstract: OBJECTIVE
  To report the outcomes of Descemet stripping automated endothelial keratoplasty (DSAEK) in patients with a previously inserted glaucoma drainage device (GDD).
  
  
  METHODS
  The clinical records of patients who had DSAEK surgery with a history of GDD insertion were reviewed.
  
  
  RESULTS
  Eleven eyes of 10 patients (7 men and 3 women) were included. The mean age for DSAEK surgery was 67.2 ± 20.4 years (range, 22-93 years). The mean follow-up after DSAEK surgery was 20.2 ± 10.7 months (range, 3-37 months). Preoperative mean logarithm of the minimum angle of resolution (logMAR)-corrected distance visual acuity was 1.8 ± 0.6 (range, 20/100 to hand motions), and this improved to 0.9 ± 0.8 (range, 20/40 to hand motions) at the final follow-up (P < 0.01). There was no statistical difference in mean pre-DSAEK versus final post-DSAEK intraocular pressure (P = 0.88). Six of 11 eyes (54.5%) had double GDD insertion before DSAEK surgery. GDD tubes were trimmed in 6 eyes (54.5%), and no eyes required further glaucoma surgical intervention after DSAEK surgery. Postoperative complications included early postoperative graft dislocation in 4 eyes (36.4%) that were successfully repositioned. Four eyes (36.4%) had an episode of endothelial rejection, with 2 patients (18.2%) requiring repeat endothelial keratoplasty for endothelial failure. The mean donor endothelial cell count was 2740 cell per square millimeter preoperatively and reduced to 858 cells per square millimeter at the final follow-up, a significant mean reduction of 69%. This was significantly greater than previously reported endothelial cell loss after DSAEK alone at our institution.
  
  
  CONCLUSIONS
  Although surgery may be more challenging, the presence of GDD is not a contraindication to DSAEK surgery. In this series, there was a high rate of dislocation that was successfully managed with rebubbling. DSAEK seems to be a reasonable alternative to penetrating keratoplasty for corneal decompensation after GDD.
authors.affiliation: Department of Ophthalmology, Toronto Western Hospital, University of Toronto, Ontario, Canada. peterkim76@gmail.com
authors.forename: Peter
authors.initials: P
authors.lastname: Kim
authors.forename: Maoz D
authors.initials: MD
authors.lastname: Amiran
authors.forename: Alejandro
authors.initials: A
authors.lastname: Lichtinger
authors.forename: Sonia N
authors.initials: SN
authors.lastname: Yeung
authors.forename: Allan R
authors.initials: AR
authors.lastname: Slomovic
authors.forename: David S
authors.initials: DS
authors.lastname: Rootman
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D057111:Descemet Stripping Endothelial Keratoplasty; D004728:Endothelium, Corneal / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D005901:Glaucoma / Q000601:surgery*; D020327:Glaucoma Drainage Implants; D006801:Humans; D008297:Male; D008875:Middle Aged; D014792:Visual Acuity; D055815:Young Adult