title: Increased Rates of Descemet's Stripping Automated Endothelial Keratoplasty (DSAEK) Graft Failure and Dislocation in Glaucomatous Eyes with Aqueous Shunts.
abstract: OBJECTIVE
  To investigate the rates of Descemet's stripping automated endothelial keratoplasty (DSAEK) graft dislocation and failure in glaucomatous eyes, including eyes with history of trabeculectomy and/or aqueous shunts.
  
  
  METHODS
  A retrospective, case-control study on a total of 424 consecutive eyes undergoing DSAEK at an academic setting compared 96 glaucomatous eyes to a control group of 328 eyes. Pre- and post DSAEK procedure data was aggregated for up to 2 years (mean follow-up, 6.5±6.9 months) including rates of graft dislocation and failure.
  
  
  RESULTS
  Out of 96 glaucomatous eyes, 20 had undergone trabeculectomy, 27 had received one or more aqueous shunts, 12 had undergone both procedures and 37 were on medical therapy. Complete DSAEK graft dislocation and failure occurred in 2.7% and 3% of non-glaucomatous patients, respectively. Eyes with history of aqueous shunt surgery experienced graft dislocation and failure rates of 26.0% (OR=4.6, 95% CI 1.5-13.7, p=0.0067) and 26.0% (OR=10.3, 95% CI 3.8-27.1, p<0.0001), respectively. In contrast, glaucomatous eyes only on medical therapy (p=0.13) or with history of trabeculectomy (p>0.40) had no significant increase in graft dislocation or failure rates.
  
  
  CONCLUSIONS
  Eyes with medically controlled glaucoma or prior trabeculectomy demonstrated comparable rates of graft dislocation and failure as compared to controls. Aqueous shunt surgery was associated with increased rates of graft dislocation and failure after DSAEK.
authors.affiliation: Wills Eye Institute/Mid Atlantic Retina, Philadelphia, PA, USA ; Duke University Eye Center, Durham, NC, USA.
authors.forename: Francis Char
authors.initials: FC
authors.lastname: Decroos
authors.forename: Derek W
authors.initials: DW
authors.lastname: Delmonte
authors.forename: Jessica H
authors.initials: JH
authors.lastname: Chow
authors.forename: Sandra S
authors.initials: SS
authors.lastname: Stinnett
authors.forename: Terry
authors.initials: T
authors.lastname: Kim
authors.forename: Alan N
authors.initials: AN
authors.lastname: Carlson
authors.forename: Natalie A
authors.initials: NA
authors.lastname: Afshari