Outcome of Descemet stripping automated endothelial keratoplasty in eyes with an Ahmed glaucoma valve.
OBJECTIVE
The purpose was to investigate the survival of Descemet stripping automated endothelial keratoplasty (DSAEK) in eyes with an Ahmed glaucoma valve (AGV).


METHODS
The study had a retrospective case-series of patients with an AGV in the anterior chamber undergoing a DSAEK. Included in the analysis were graft size, number of previous operations, post-operative glaucoma medications, post-operative intraocular pressure (IOP) control, graft size and donor factors (age, endothelial cell density, and post-mortem time). A generalised linear model with binary logistic regression was used to test for an effect on graft survival at 1 year and 1.5 years.


RESULTS
Fourteen eyes from 13 patients were included. The survival rate of the first DSAEK at 6, 12, 18, 24 and 30-months was 85%, 71%, 50%, 36% and 30%, respectively. The mean duration to graft failure was 12.9 ± 6.2 months. Five of the seven failed first grafts went on to have a repeat DSAEK. The mean follow-up in this subgroup was 30.7 ± 18.4 months. The survival rate of second DSAEK at 6, 12, 18 and 24 months was 100% (5/5), 100% (5/5), 75% (3/4) and 67% (2/3). Only one second DSAEK failed in the duration of the study and went on to receive a third DSAEK which failed at 18-months. The mean IOP within the first year was significantly lower for grafts that survived at 1 and 1.5 years (17.4 mmHg, 16.9 mmHg) than for grafts that failed (19.4 mmHg, 19.4 mmHg) (p = 0.04, p = 0.009).


CONCLUSIONS
DSAEK is a viable alternative to PK to restore visual function in eyes with an AGV sited in the anterior chamber. IOP is an important risk factor for graft failure.
St. Paul's Eye Unit, Royal Liverpool University Hospital, Liverpool, England. pjtchiam@yahoo.com.|Eye Care Centre, Leighton Hospital, Middlewich Road, Crewe, CW1 4QJ, England. pjtchiam@yahoo.com.
Patrick J
PJ
Chiam
St. Paul's Eye Unit, Royal Liverpool University Hospital, Liverpool, England.
Robert
R
Cheeseman
St. Paul's Eye Unit, Royal Liverpool University Hospital, Liverpool, England.
Vivian W
VW
Ho
St. Paul's Eye Unit, Royal Liverpool University Hospital, Liverpool, England.
Vito
V
Romano
St. Paul's Eye Unit, Royal Liverpool University Hospital, Liverpool, England.
Anshoo
A
Choudhary
St. Paul's Eye Unit, Royal Liverpool University Hospital, Liverpool, England.
Mark
M
Batterbury
St. Paul's Eye Unit, Royal Liverpool University Hospital, Liverpool, England.|Department of Eye and Vision Science, Institute of Ageing and Chronic Disease, Faculty of Health & Life Sciences, University of Liverpool, Liverpool, England.
Stephen B
SB
Kaye
St. Paul's Eye Unit, Royal Liverpool University Hospital, Liverpool, England.|Department of Eye and Vision Science, Institute of Ageing and Chronic Disease, Faculty of Health & Life Sciences, University of Liverpool, Liverpool, England.
Colin E
CE
Willoughby
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003316:Corneal Diseases / Q000150:complications / Q000601:surgery*; D057111:Descemet Stripping Endothelial Keratoplasty / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D005901:Glaucoma / Q000150:complications* / Q000601:surgery; D020327:Glaucoma Drainage Implants; D006085:Graft Survival; D006801:Humans; D007429:Intraocular Pressure; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013997:Time Factors; D014792:Visual Acuity
AGV; Ahmed glaucoma valve; DSAEK; Descemet stripping automated endothelial keratoplasty; Endothelial keratoplasty; Glaucoma drainage device; Graft survival