title: Outcomes after DSEK in 101 eyes with previous trabeculectomy and tube shunt implantation.
abstract: OBJECTIVE
  The aim of this study was to determine the outcomes after Descemet stripping endothelial keratoplasty (DSEK) in eyes with previous glaucoma surgery.
  
  
  METHODS
  This is a retrospective review of all DSEK procedures performed by 2 surgeons from May 1, 2006, to December 31, 2012.
  
  
  RESULTS
  Four hundred sixty-two DSEK procedures were performed, of which 113 (24%) were performed in 101 eyes after a trabeculectomy (52 procedures) and/or tube shunt implantation (76 procedures) (15 procedures in eyes with both). Primary graft failure and donor dislocation developed in 4.4% and 14.2% of cases in eyes with previous glaucoma surgery, not significantly different from the 3.2% (P = 0.56) and 11.5% (P = 0.51) in eyes without prior glaucoma surgery. During a mean follow-up of 20.7 ± 17.6 months, endothelial rejection developed in a greater percentage of eyes with previous glaucoma surgery (12.9%; 0.069/eye-year) compared with that in eyes without surgery (6.9%; 0.042/eye-year), although the difference was not statistically significant (P = 0.066 for percentage of eyes; P = 0.16 for rejection rate). Secondary graft failure developed in a significantly higher percentage of eyes with previous glaucoma surgery (15.9%; 0.094/eye-year) compared with that in eyes without surgery (3.2%; 0.019/eye-year) (P < 0.0001; P < 0.0001). Elevated intraocular pressure after DSEK was significantly more common in eyes with medically treated glaucoma (41.3%; 0.345/eye year) than in eyes with a previous glaucoma surgery (23.8%; 0.145/eye-year) and without glaucoma (20.0%; 0.138/eye year) (P = 0.009; P = 0.007).
  
  
  CONCLUSIONS
  Although intraoperative and early postoperative complications such as donor dislocation and primary graft failure are not significantly more common after DSEK in eyes with previous glaucoma surgery, secondary graft failure is. In contrast, other postoperative complications such as elevated intraocular pressure are significantly more common in eyes with medically treated glaucoma than in eyes with previous glaucoma surgery and without glaucoma.
authors: Jules Stein Eye Institute, David Geffen School of Medicine, The University of California, Los Angeles, CA.
authors: Anthony J
authors: AJ
authors: Aldave
authors: Judy L
authors: JL
authors: Chen
authors: Arman S
authors: AS
authors: Zaman
authors: Sophie X
authors: SX
authors: Deng
authors: Fei
authors: F
authors: Yu
mesh_terms: D000368:Aged; D015715:Corneal Edema / Q000601:surgery*; D055954:Corneal Endothelial Cell Loss / Q000175:diagnosis; D057111:Descemet Stripping Endothelial Keratoplasty / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D005642:Fuchs' Endothelial Dystrophy / Q000601:surgery*; D005901:Glaucoma / Q000601:surgery*; D020327:Glaucoma Drainage Implants; D006084:Graft Rejection / Q000175:diagnosis; D006801:Humans; D007429:Intraocular Pressure / Q000502:physiology; D007431:Intraoperative Complications; D008297:Male; D011183:Postoperative Complications; D011184:Postoperative Period; D012189:Retrospective Studies; D014130:Trabeculectomy; D016896:Treatment Outcome; D014792:Visual Acuity / Q000502:physiology