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Prior incisional glaucoma surgery increases graft failure and dislocation in eyes undergoing Descemet’s stripping automa

Prior incisional glaucoma surgery increases graft failure and dislocation in eyes undergoing Descemet’s stripping automated endothelial keratoplasty (DSAEK). Francis Char DeCroos, MD Derek W. DelMonte, MD Jessica H. Chow, MD Terry Kim, MD Alan N. Carlson, MD Natalie A. Afshari, MD

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Prior incisional glaucoma surgery increases graft failure and dislocation in eyes undergoing Descemet’s stripping automa

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  1. Prior incisional glaucoma surgery increases graft failure and dislocation in eyes undergoing Descemet’s stripping automated endothelial keratoplasty (DSAEK). Francis Char DeCroos, MD Derek W. DelMonte, MD Jessica H. Chow, MD Terry Kim, MD Alan N. Carlson, MD Natalie A. Afshari, MD Duke Eye Center The authors have no financial interest in the subject matter of this poster.

  2. Purpose • To investigate the relationship between prior incisional glaucoma surgery and the rates of DSAEK graft dislocation and failure. • Has not been previously examined in a large series

  3. Hypothesis • Challenges in glaucomatous eyes • Increased rate of PAS1 • Increased rate of narrow angles or shallow AC2 • Difficulty in obtaining appropriate AC air fill3 • Manipulation with indwelling shunt • 1.8X chance of increased rejection4 1. Lee, Kor J Ophthalmol, 2006. 2. Bonomi, Ophthalmol, 2000;3. Ide, Open Ophthal J, 2009; 4. Price, Br J Ophthalmol, 2009.

  4. 4 Indwelling Glaucoma Tubes Post Operative Appearance DSAEK Please select “view additional images/video” for surgical video. Air Escape Into Trab During DSAEK Air Fill Courtesy of Dr. Alan N. Carlson, Duke Eye Center

  5. Methods • Retrospective case-control study • Cases: Prior diagnosis of glaucoma • No history of incisional glaucoma surgery • Prior trabeculectomy and/or aqueous shunt(s) • Controls: No prior diagnosis of glaucoma • Include only first DSAEK in any eye

  6. Patient Demographics

  7. Pre-Operative

  8. BCVA *p<0.05 at all evaluated time points

  9. Glaucoma Subgroup Analysis Glaucoma n = 96 No Prior Incisional Surgery n = 37 Incisional Surgery n= 59 Trab n = 20 Tube n = 27 Trab+Tube n = 12 Multi-Tube n = 10

  10. DSAEK Dislocation Rates

  11. DSAEK Failure Rates

  12. Conclusions • Prior Glaucoma Surgery • Risk factor for graft dislocation • Risk factor for graft failure • Indwelling multiple tubes • Increased risk for graft failure and dislocation

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