Post-DSEK glaucoma patients can be treated with trabeculotomy

The authors of this brief "PostScript" article report on the successful treatment with trabeculotomy of four glaucoma patients who had undergone Descemet stripping endothelial keratoplasty (DSEK) a mean of 4.5 months earlier. Best-corrected visual acuity improved from 0.88 logMAR preoperatively to 0.7 logMAR after surgery. IOP dropped significantly from 30.3 mm Hg preoperatively to 14.3 mm Hg six months after surgery. The mean number of antiglaucoma medications was reduced from 5.3 preoperatively to 2.0 six months after surgery. All patients had a clear cornea and improved visual acuity after surgery.

Prior to undergoing DSEK, two patients were diagnosed with pseudophakic bullous keratopathy and two with laser-iridotomy-induced bullous keratopathy. Two had pre-existing angle-closure glaucoma. Three underwent DSEK only, while one was treated with DSEK and cataract surgery with posterior chamber IOL implantation.

All patients experienced postoperative transient high IOP and mild hyphema that resolved spontaneously with antiglaucoma medication, but there were no other postoperative complications.

The authors said this is the first study to describe glaucoma after DSEK and its successful treatment with trabeculotomy. They described the treatment as safe and effective for post-DSEK glaucoma patients in comparison with trabeculectomy for glaucoma after keratoplasty, which is not sufficiently safe and effective and is associated with complications like graft failure, persistent epithelial defect and a shallow anterior chamber that are rare after trabeculotomy.