title: Combined deep sclerectomy and descemet stripping automated endothelial keratoplasty.
abstract: OBJECTIVE
  The aim of this study was to evaluate a novel surgical combination of Descemet stripping automated endothelial keratoplasty (DSAEK) and deep sclerectomy (DS) for the management of concomitant corneal endothelial decompensation and uncontrolled glaucoma.
  
  
  METHODS
  This retrospective case series noncomparative study included 9 eyes of 6 consecutive patients with coexistence of corneal edema resulting from Fuchs dystrophy or pseudoexfoliation keratopathy and medically uncompensated glaucoma; these patients underwent combined DSAEK and DS with mitomycin C and an absorbable collagen implant. Corneal graft clarity, endothelial cell density, visual acuity, intraocular pressure (IOP), and identification of complications were assessed over a 2-year follow-up.
  
  
  RESULTS
  All eyes obtained graft clarity throughout the follow-up, with a final average endothelial cell decrease of -36% from baseline, and showed improved vision and good IOP control without hypotensive therapy. Measured at 3 and 24 months postoperation, the mean visual acuity improvement was 154% and 372% and IOP decrease was 51.1% and 46.4%, respectively. Two anterior segment complications occurred in 2 (22%) patients' eyes. This consisted of a graft dislocation and a modest IOP elevation, treated successfully.
  
  
  CONCLUSIONS
  Combined DSAEK and DS was longitudinally associated with good corneal graft survival and IOP control, with few complications. These findings suggest that this surgical approach is a viable option for patients with coexisting glaucoma and corneal endothelial dysfunction. Our study should stimulate a multicenter, randomized, controlled trial of our technique.
authors.affiliation: *Santa Croce e Carle Hospital, Cuneo, Italy; and †the Department of Surgical Sciences for Diseases of the Head and Neck, Institute of Ophthalmology, Catholic University, Rome, Italy.
authors.forename: Agostino S
authors.initials: AS
authors.lastname: Vaiano
authors.forename: Tommaso
authors.initials: T
authors.lastname: Salgarello
authors.forename: Andrea
authors.initials: A
authors.lastname: Giudiceandrea
authors.forename: Monica
authors.initials: M
authors.lastname: Riso
authors.forename: Maria G
authors.initials: MG
authors.lastname: Sammarco
authors.forename: Guido
authors.initials: G
authors.lastname: Caramello
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002452:Cell Count; D003315:Cornea / Q000503:physiopathology; D015715:Corneal Edema / Q000150:complications / Q000601:surgery*; D057111:Descemet Stripping Endothelial Keratoplasty; D004728:Endothelium, Corneal / Q000473:pathology; D005260:Female; D005901:Glaucoma / Q000150:complications / Q000601:surgery*; D006801:Humans; D007429:Intraocular Pressure / Q000502:physiology; D008297:Male; D008875:Middle Aged; D016685:Mitomycin / Q000008:administration & dosage; D012189:Retrospective Studies; D012599:Sclerostomy; D014792:Visual Acuity / Q000502:physiology
chemical_list: D016685:Mitomycin