title: Outcomes After Descemet Stripping Automated Endothelial Keratoplasty in Patients With Glaucoma Drainage Devices.
abstract: OBJECTIVE
  To evaluate outcomes after Descemet stripping automated endothelial keratoplasty in eyes with glaucoma drainage devices.
  
  
  METHODS
  This is a retrospective review of 24 cases performed by a single surgeon (S.B.H.) on 20 eyes. Data were gathered on demographics, ocular history, surgical details, and postoperative outcomes. Outcome measures included primary graft failure, secondary graft failure, endothelial cell density (ECD), central corneal thickness (CCT), intraocular pressure, and visual acuity.
  
  
  RESULTS
  With a mean follow-up of 30.3 ± 19.6 months, there was no occurrence of primary graft failure, and the rate of secondary graft failure was 29%. Survival rates at 1, 2, and 3 years, respectively, were 87% [95% confidence interval (CI): 65%-96%], 80% (95% CI: 55%-92%), and 70% (95% CI: 39%-88%). Compared with ECD of the donor lenticule, endothelial cell loss was 49 ± 16% (n = 21) at postoperative month 3, 59 ± 16% (n = 20) at month 6, 61 ± 20% (n = 16) at month 12, and stabilized at 75 ± 17% (n = 9) by month 18. Compared with CCT during the visit before surgery, CCT decreased to 83 ± 18% (n = 18) at postoperative month 3 and gradually increased to 95 ± 11% (n = 6) at month 24. There were 4 (17%) cases of intraocular pressure elevation above 25 mm Hg. Improved visual acuity occurred in 71% of patients.
  
  
  CONCLUSIONS
  Descemet stripping automated endothelial keratoplasty in eyes with corneal edema secondary to endothelial dysfunction in the presence of a previous glaucoma drainage device is a successful procedure. However, intermediate term endothelial cell loss is significant, as is the graft failure rate.
authors.affiliation: *Cornea Service, Wills Eye Hospital, Philadelphia, PA; †Sindey Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA; and ‡Oxford Valley Laser Vision Center, Langhorne, PA.
authors.forename: Nina
authors.initials: N
authors.lastname: Ni
authors.forename: Brian J
authors.initials: BJ
authors.lastname: Sperling
authors.forename: Yang
authors.initials: Y
authors.lastname: Dai
authors.forename: Sadeer B
authors.initials: SB
authors.lastname: Hannush
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002452:Cell Count; D015715:Corneal Edema / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D055954:Corneal Endothelial Cell Loss / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D057111:Descemet Stripping Endothelial Keratoplasty / Q000379:methods*; D004728:Endothelium, Corneal / Q000473:pathology; D005260:Female; D005500:Follow-Up Studies; D005901:Glaucoma / Q000601:surgery*; D020327:Glaucoma Drainage Implants; D006085:Graft Survival / Q000502:physiology; D006801:Humans; D007429:Intraocular Pressure / Q000502:physiology; D008297:Male; D008875:Middle Aged; D019919:Prosthesis Implantation; D012189:Retrospective Studies; D016896:Treatment Outcome; D014792:Visual Acuity / Q000502:physiology