Ophthalmology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx.
Ophthalmology, New York Eye and Ear Infirmary, Mt. Sinai School of Medicine.
J Glaucoma. 2019 Jul;28(7):601-605. doi: 10.1097/IJG.0000000000001272.
In this retrospective case series of 85 eyes, 31.8% developed graft failure and graft survival was 50% at 3 years. The presence of an aqueous shunt has a significantly adverse effect on long-term graft survival.
To report visual outcomes and complications of Descemet stripping endothelial keratoplasty (DSEK) in eyes with glaucoma drainage devices (GDD).
A retrospective chart review was conducted of 122 procedures of 85 eyes of 83 patients who underwent DSEK and had prior or concurrent GDD implantation. Mean follow-up was 36.5±31.4 months. Patients with postoperative follow-up of <3 months were excluded from analysis. Outcome measures examined included visual acuity, donor dislocation rate, intraocular pressure (IOP), and graft survival.
The mean logMAR vision improved to 1.07 postoperatively from 1.43 preoperatively, with 61% of eyes experiencing improved visual acuity. Graft dislocation occurred in 27 (31.8%) eyes and required repeat injection of air in the anterior chamber. Primary graft failure occurred in 2 (2.4%) eyes, whereas secondary graft failure occurred in 27 (31.8%) of eyes, with an average time of 24.3 months for development. Estimated survival rates at 1, 2, and 3 years were 89%, 78%, and 50%, respectively. Escalation of IOP occurred in 21 (24.7%) eyes postoperatively, where 14 eyes underwent medical therapy and 7 eyes required surgical intervention/laser for IOP control.
DSEK after GDD is a viable alternative to treat endothelial dysfunction, with the majority of patients achieving visual improvement. However, aqueous shunt implantation has a significantly adverse effect on long-term graft survival and close follow-up is warranted.
在这项 85 只眼的回顾性病例系列研究中，31.8%的患者发生移植物失功，3 年时的移植物存活率为 50%。房水引流装置的存在对视物功能长期存活率有显著不良影响。
报告青光眼引流装置（GDD）植入术后行撕囊的内皮角膜移植术（DSEK）的视力结果和并发症。
对 83 例 85 只眼共行 122 例 DSEK 手术患者的病历进行回顾性分析，这些患者均有 GDD 植入或同时有 GDD 植入。平均随访时间为 36.5±31.4 个月。排除术后随访时间＜3 个月的患者。观察指标包括视力、供体脱位率、眼内压（IOP）和移植物存活率。
术后平均 logMAR 视力从术前的 1.43 提高到 1.07，61%的眼视力改善。27 只（31.8%）眼发生移植物脱位，需前房内重复注入空气。2 只（2.4%）眼发生原发性移植物失功，27 只（31.8%）眼发生继发性移植物失功，平均发生时间为 24.3 个月。1、2、3 年的估计存活率分别为 89%、78%和 50%。术后 21 只（24.7%）眼眼压升高，其中 14 只眼接受药物治疗，7 只眼需要手术干预/激光治疗以控制眼压。
DSEK 是 GDD 后治疗内皮功能障碍的一种可行方法，大多数患者视力提高。然而，房水引流装置的植入对视物功能长期存活率有显著不良影响，需要密切随访。
