Visual Acuity and Intraocular Pressure after Descemet's Stripping Endothelial Keratoplasty in Eyes with and without Preexisting Glaucoma
Presented at: The American Academy of Ophthalmology Annual Meeting, November 2008, Atlanta, Georgia. Awarded session best paper
Received 10 December 2008; received in revised form 17 May 2009; accepted 26 May 2009. published online 29 July 2009.
Purpose
(1) To characterize the pattern of intraocular pressure (IOP) changes after Descemet's stripping endothelial keratoplasty (DSEK) in patients without preexisting glaucoma and in those with preexisting glaucoma, with and without prior glaucoma surgery. (2) To compare vision and IOP outcomes among the 3 groups.
Design
A retrospective chart review.
Participants
A total of 805 DSEK cases performed in 641 patients by a single surgeon from December 2003 to August 2007 were available in the database. Only the first-treated eye of each patient with at least 1-year follow-up was included. Four hundred cases qualified: 315 eyes had no glaucoma (C); 64 eyes had glaucoma with no previous glaucoma surgery (G); and 21 eyes had prior glaucoma surgery (GS). Eyes with preexisting retinal problems were included in the analysis.
Methods
Data analysis included calculation of incidence of postoperative IOP elevation. The study criteria for postoperative IOP elevation were IOP ≥24 mmHg or IOP increase ≥10 mmHg from baseline. Kruskal–Wallis test was used to compare visual acuity (VA) and IOP among the 3 groups preoperatively and at 1-, 3-, 6-, and 12-month postoperative visits.
Main Outcome Measures
Visual acuity (Snellen) and IOP (millimeters of mercury).
Results
The incidence of postoperative IOP elevation by the study criteria was 35%, 45%, and 43% for groups C, G, and GS, respectively. Elevated IOP was medically managed by initiating or increasing glaucoma medications or reducing steroids in 27%, 44%, and 38% of the patients in groups C, G, and GS, respectively. A subsequent glaucoma procedure was performed in 0.3%, 5%, and 19% of patients in groups C, G, and GS, respectively. Only the control group had statistically significant IOP elevation at 12 months (median increase of 2 mmHg) when compared with baseline (P<0.0001). All 3 groups had statistically significant improvement in vision at 12 months when compared with baseline (12-month median VA = 20/40 for C and G; and 20/50 for GS, P<0.0001).
Conclusions
All groups had a substantial incidence of IOP elevation after DSEK. Close monitoring of IOP is warranted. In this cohort, preexisting glaucoma did not seem to have a negative effect on VA after DSEK.
Financial Disclosure(s)
Proprietary or commercial disclosure may be found after the references.
Available online: July 29, 2009.
1Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, Illinois
2Cornea Research Foundation of America, Indianapolis, Indiana
4Center of Clinical and Translational Sciences, University of Illinois, Chicago, Illinois
5Department of Ophthalmology, Summa Health System, Akron, Ohio
Correspondence: Thasarat S. Vajaranant, MD, University of Illinois at Chicago, Ophthalmology, 1855 W. Taylor Street, Chicago, IL 60612
Manuscript no. 2008-1475.
Financial Disclosure(s): The author(s) have made the following disclosure(s): FWP is a consultant for Alcon (Fort Worth, TX) and Allergan, Inc. (Irvine, CA). JTW receives honoraria from Alcon, Allergan, Inc., and Pfizer (New York, NY). DPE is a consult for Alcon and receives honoraria from Allergan, Inc.
Financial support provided by the Carlson Gabriel Fund, Chicago, IL and the University of Illinois at Chicago (UIC) Center for Clinical and Translational Science (CCTS), which was funded in part by the National Center for Research Resources, National Institutes of Health, planning grant 1 P20 RR023411–01.
ABSTRACT