Department of Ophthalmology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY.
Department of Ophthalmology, New York Eye and Ear Infirmary, Mt. Sinai Icahn School of Medicine, New York, NY.
Cornea. 2019 Nov;38(11):1364-1369. doi: 10.1097/ICO.0000000000002059.
To compare visual outcomes and complications of Descemet stripping endothelial keratoplasty (DSEK) in eyes with anterior chamber (AC) versus pars plana (PP) glaucoma drainage devices (GDDs).
A retrospective chart review was conducted of 85 eyes that underwent DSEK and had previous or concurrent AC (37 eyes) or PP (48 eyes) GDD implantation. Outcome measures examined included visual acuity, donor dislocation rate, intraocular pressure, and secondary graft failure (SGF).
The mean logarithm of the minimum angle of resolution vision improved from 1.50 (SD = 0.64) to 0.88 (SD = 0.71) in the AC group and from 1.37 (SD = 0.59) to 1.20 (SD = 0.76) in the PP group, with no significant group difference. Intraocular pressure did not differ between the groups preoperatively but was higher in the AC group compared with the PP group postoperatively [mean (SD) 14.5 (6.28) versus 11.5 (5.54) mm Hg, P = 0.03]. Graft dislocation occurred in 35.1% and 29.2% of eyes in the AC and PP groups, respectively. SGF occurred in 18.9% and 41.7% with median time 17.1 (interquartile range [IQR] 4.6-32.1) and 27.9 (IQR 15.1-34.7) months to development in the AC and PP groups, respectively. Multivariable logistic and Cox proportional hazards regression models found no statistically significant factors (tube location, age, sex, concurrent tube revision, new tube insertion) associated with either donor dislocation or SGF.
There was no reduction in donor dislocation or SGF in eyes with PP compared with AC GDD, despite the decreased proximity of the shunt from the endothelial graft. Overall, GDD has a significantly adverse effect on long-term graft survival and close follow-up is warranted.
比较前房（AC）与后房（PP）青光眼引流装置（GDD）眼行撕囊内皮角膜移植术（DSEK）的视力结果和并发症。
对 85 例接受 DSEK 并同时植入前房 GDD（37 例）或后房 GDD（48 例）的患者进行回顾性图表分析。观察指标包括视力、供体脱位率、眼内压和继发性移植物失功（SGF）。
AC 组平均最小分辨角视力对数从 1.50（标准差=0.64）提高到 0.88（标准差=0.71），PP 组从 1.37（标准差=0.59）提高到 1.20（标准差=0.76），但两组间差异无统计学意义。两组术前眼内压无差异，但术后 AC 组眼内压高于 PP 组[平均（标准差）为 14.5（6.28）比 11.5（5.54）mmHg，P=0.03]。AC 组和 PP 组分别有 35.1%和 29.2%的眼发生供体脱位。SGF 分别发生在 18.9%和 41.7%的眼中，中位时间分别为 17.1（四分位距 [IQR]：4.6-32.1）和 27.9（IQR：15.1-34.7）个月。多变量逻辑和 Cox 比例风险回归模型发现，供体脱位或 SGF 与管位置、年龄、性别、同时行管修复、新插入管等因素均无统计学关联。
尽管引流管与内皮移植物的距离减小，但与前房 GDD 相比，后房 GDD 并未降低供体脱位或 SGF 的发生率。总体而言，GDD 对长期移植物存活率有显著不良影响，需要密切随访。
