Brian J. Sperling

Outcomes After Descemet Stripping Automated Endothelial Keratoplasty in Patients With Glaucoma Drainage Devices.

Purpose: 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.

Descemet stripping endothelial keratoplasty for the treatment of combined fuchs corneal endothelial dystrophy and keratoconus.

Purpose: To report the first case series of patients with Fuchs corneal endothelial dystrophy (FCD) and keratoconus (KCN) who underwent Descemet stripping endothelial keratoplasty (DSEK). Methods: This is a retrospective case series of 6 eyes of 4 patients with combined FCD and KCN who underwent DSEK at 3 different centers. Clinical information collected included corneal topography measurements, central corneal thickness, and endothelial cell count. Visual outcomes and change in keratometric measurements were evaluated. Results: The follow-up for patients ranged from 10 to 72 months. The best-corrected visual acuity was 20/40 or better in all 6 eyes. The mean keratometric measurements decreased in all cases (range of 0.5–5.8 diopters); however, topography still demonstrated an inferior steepening in each case. Conclusions: Patients with FCD and KCN have been previously reported as being managed with penetrating keratoplasty. We present 6 eyes of 4 patients who were managed with DSEK for the FCD. Topographically, the characteristic inferior steepening of KCN did not change; however, all patients with DSEK had flatter postoperative keratometric measurements with improved visual acuity. If a DSEK is performed for FCD before apical corneal scarring from KCN, a good visual outcome may be achieved.