Sofia Fili1, Kalliopi Kontopoulou2, Nikolaos Bechrakis3, Markus Kohlhaas2. 1. Department of Ophthalmology, Clinic of Ophthalmology, St. Johannes Hospital, Johannesstraße 9-13, 44137, Dortmund, Germany. sofia.fili@joho-dortmund.de. 2. Department of Ophthalmology, Clinic of Ophthalmology, St. Johannes Hospital, Johannesstraße 9-13, 44137, Dortmund, Germany. 3. Department of Ophthalmology, University Hospital of Essen, Essen, Germany.
Abstract
BACKGROUND: Glaucoma can cause corneal decompensation and accelerate the failure of the graft. Previous antiglaucoma operations are one of the most important risk factors for endothelial failure. METHODS: In this retrospective study, 40 eyes of 40 glaucoma patients with advanced corneal decompensation after glaucoma surgery were treated with keratoplasty and outcomes were assessed for 24 months. RESULTS: 16, 9 and 15 eyes underwent Descemet Membrane Endothelial Keratoplasty (DMEK), Descemet's Stripping Automated Endothelial Keratoplasty (DSAEK) and penetrating keratoplasty (pKPL), respectively. Visual acuity improved at least 2 lines in 24 of 40 eyes after the three types of keratoplasty. All 40 eyes remained pain free for the follow-up period. The mean intraocular pressure (IOP) difference was not significantly different (p > 0.05) from the preoperative values 12 and 24 months after keratoplasty. The endothelial cell density of the donor cornea decreased from 2485.6 ± 165.18 to 1291.4 ± 467.1 and 1180.4 ± 397.2/mm2 (p < 0.001) after 12 and 24 months, respectively. Nine eyes (22.5%) had therapy-resistant corneal decompensation in the context of a transplant failure and were treated with a re-keratoplasty (2 re-pKPLs, 3 re-DSAEKs and 3 re-DMEKs). CONCLUSIONS: Eyes with previous glaucoma surgery show satisfying results after keratoplasty, mainly DMEK and pKPL.
BACKGROUND:Glaucoma can cause corneal decompensation and accelerate the failure of the graft. Previous antiglaucoma operations are one of the most important risk factors for endothelial failure. METHODS: In this retrospective study, 40 eyes of 40 glaucomapatients with advanced corneal decompensation after glaucoma surgery were treated with keratoplasty and outcomes were assessed for 24 months. RESULTS: 16, 9 and 15 eyes underwent Descemet Membrane Endothelial Keratoplasty (DMEK), Descemet's Stripping Automated Endothelial Keratoplasty (DSAEK) and penetrating keratoplasty (pKPL), respectively. Visual acuity improved at least 2 lines in 24 of 40 eyes after the three types of keratoplasty. All 40 eyes remained pain free for the follow-up period. The mean intraocular pressure (IOP) difference was not significantly different (p > 0.05) from the preoperative values 12 and 24 months after keratoplasty. The endothelial cell density of the donor cornea decreased from 2485.6 ± 165.18 to 1291.4 ± 467.1 and 1180.4 ± 397.2/mm2 (p < 0.001) after 12 and 24 months, respectively. Nine eyes (22.5%) had therapy-resistant corneal decompensation in the context of a transplant failure and were treated with a re-keratoplasty (2 re-pKPLs, 3 re-DSAEKs and 3 re-DMEKs). CONCLUSIONS: Eyes with previous glaucoma surgery show satisfying results after keratoplasty, mainly DMEK and pKPL.
Authors: Robert M Knape; Tiffany N Szymarek; Sonal S Tuli; William T Driebe; Mark B Sherwood; Mary Fran Smith Journal: J Glaucoma Date: 2012-12 Impact factor: 2.503