Glaucoma surgery linked to reduced DSEK graft survival

This large retrospective study found that eyes with prior glaucoma surgery were far more likely to have secondary graft failure after DSEK than eyes without prior glaucoma surgery.

This is the largest study of its kind in the literature. It highlights the long-term challenges of DSEK surgery in the context of prior glaucoma surgery and the importance of close IOP monitoring postoperatively in all patients with a history of glaucoma.

The authors reviewed all DSEK procedures performed by two surgeons at the Jules Stein Eye Institute at UCLA from May 1, 2006, to December 31, 2012.

Intraoperative and early postoperative complications, such as donor dislocation and primary graft failure, were comparable between eyes with and without prior glaucoma surgery. However, eyes with prior glaucoma surgery had a significantly higher risk of developing secondary graft failure than those without prior glaucoma surgery (15.9% vs. 3.2%). 

There was no significant difference in the rate of secondary graft failure between eyes with previous trabeculectomy and eyes with prior tube shunts. However, elevated IOP was significantly more common in eyes with medically treated glaucoma (41.3%) than in eyes with previous glaucoma surgery (23.8%) and eyes without glaucoma (20%).

They conclude that the significantly higher rate of secondary graft failure in eyes with a previous trabeculectomy and tube shunt implantation should make glaucoma surgeons consider other surgical options that do not compromise the blood–aqueous barrier, such as minimally invasive glaucoma procedures and selective cyclodestructive procedures, for the management of elevated IOP in eyes after a keratoplasty or in eyes at increased risk of developing corneal endothelial decompensation.