1. 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.

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 2

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, Bonomi, Ophthalmol, 2000;3. Ide, Open Ophthal J, 2009; 4. Price, Br J Ophthalmol, 2009.

4. 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

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 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

7. 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

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

9. 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

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

11. 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

12. 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