Outcome of endothelial keratoplasty in bullous keratopathy with glaucoma vs Fuchs’ endothelial dystrophy
First Author: M.Ahad SAUDI ARABIA
To determine the outcome of Descemet’s stripping automated endothelial keratoplasty (DSAEK) in different subgroups of patient with corneal endothelial decompensation.
Retrospective study conducted at two eye hospitals
Retrospective study of patients who underwent (DSAEK) by a single surgeon and had completed 2 years of follow up. Cases were divided into four subgroups depending upon indication. 1) Fuchs’ dystrophy (FED), 2) Bullous keratopathy (BK), 2) BK with associated glaucoma and 4) BK in patients with glaucoma drainage device (GDD). Patients with herpetic eye disease, re-do cases and trauma were excluded. Main outcome measure was graft survival at 2 year, post-operatively.
Seventy-seven eyes of 70 subjects fulfilled the inclusion criteria. The mean age at time of surgery was 72-years and there were 38 males. There were 36 cases of FED, 24 cases of BK, 10 cases of BK with glaucoma and 7 cases of BK and GDD. The overall survival at two years was 89.6% (69/77). Success rate was 100% in FED, 91.6% in BK, 70% in BK with glaucoma and 57.1% in BK with GDD. There was one primary failure that occurred in group-4. All the three failures in BK with glaucoma happened after rejection, and all had previous trabeculectomy.
DSAEK in patients with BK with glaucoma and / or GDD has worse outcome compared to FED. Rejection is common, particularly if there is a previous glaucoma surgery.