Francis Char DeCroos, MD 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.

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 2

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.

Please select “view additional images/video” for surgical video. 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

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

Patient Demographics Control Glaucoma Total Patients 328 96 424 AGE 69.2 ± 11.3 70.79 ± 17.7 SEX Male 114 44 Female 214 52 RACE White 275 71 Black 28 20 Other 25 5

Pre-Operative Glaucoma Control P-Value BCVA (logMar) 1.46 ± 0.84 0.66 ± 0.54 <0.0001 IOP 15.2 ± 5.9 14.9 ± 3.7 0.60 Pachymetry 701.7 660.7 0.046

BCVA *p<0.05 at all evaluated time points

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

DSAEK Dislocation Rates Glaucoma Control P-Value Odds Ratio Dx Glaucoma 10.4% 2.7% 0.0034 4.1 No Prior Surgery 1.00 0.98 Prior Surgery 15.3% 0.0001 7.23 Multi -Tube 30.0% 0.0035 15.19

DSAEK Failure Rates Glaucoma Control P-Value Odds Ratio Dx Glaucoma 15.6% 3.0% 0.0003 5.9 No Prior Surgery 8.1% 0.135 2.80 Prior Surgery 20.3% <0.0001 10.84 Multi -Tube 20.0% 0.0044 7.95

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