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Graft Dislocation and Hypotony after Descemet's Stripping Automated Endothelial Keratoplasty in Patients with Previous Glaucoma Surgery

Graft Dislocation and Hypotony after Descemet's Stripping Automated Endothelial Keratoplasty in Patients with Previous Glaucoma Surgery

Jeffrey M. Goshe, MD ; Mark A. Terry, MD; Jennifer Y. Li, MD; Michael D. Straiko, MD; David Davis-Boozer, MPH

Purpose

To determine if patients with prior glaucoma surgery experience higher rates of postoperative graft dislocation after Descemet’s stripping automated endothelial keratoplasty (DSAEK) and to determine if postoperative hypotony may be a risk factor in these patients.

Design

Retrospective, comparative analysis of an interventional case series.

Participants

Eight hundred fifty-four eyes (67 eyes with prior glaucoma surgery and 787 controls) from 582 patients who underwent DSAEK at 1 institution between January 2005 and April 2011.

Methods

Groups were compared with regard to preoperative, intraoperative, and postoperative parameters. Continuous variables were compared using the independent samples t test or Mann–Whitney U test. Categorical variables were compared using the chi-square test or Fisher exact test.

Main Outcome Measures

Frequencies of postoperative graft dislocation and postoperative hypotony.

Results

Study eyes before surgery differed from control eyes with regard to corneal thickness (768 vs. 655 μm; P<0.001) and intraocular pressure (13 vs. 16 mmHg; P<0.001). Postoperative graft dislocation occurred significantly more frequently in study eyes compared with control eyes (9% vs. 2%; P = 0.008). Among eyes in which dislocation occurred, postoperative hypotony was present in 5 study eyes (83%) and 0 control eyes.

Conclusions

Previous glaucoma surgery was associated with a significantly increased rate of graft dislocation compared with control eyes. Dislocation was related strongly to postoperative hypotony in eyes with prior glaucoma surgery.