Graft Dislocation and Hypotony after Descemet's Stripping Automated Endothelial Keratoplasty in Patients with Previous Glaucoma Surgery

Purpose: To determine if patients with prior glaucoma surgery experience higher rates of postoperative graft dislocation after Descemet's stripping automated endothelial keratoplasty (DSAEK) and to determine if postoperative hypotony may be a risk factor in these patients. Design: Retrospective, comparative analysis of an interventional case series. Participants: Eight hundred fifty-four eyes (67 eyes with prior glaucoma surgery and 787 controls) from 582 patients who underwent DSAEK at 1 institution between January 2005 and April 2011. Methods: Groups were compared with regard to preoperative, intraoperative, and postoperative parameters. Continuous variables were compared using the independent samples t test or Mann-Whitney U test. Categorical variables were compared using the chi-square test or Fisher exact test. Main Outcome Measures: Frequencies of postoperative graft dislocation and postoperative hypotony. Results: Study eyes before surgery differed from control eyes with regard to corneal thickness (768 vs. 655 mu m; P<0.001) and intraocular pressure (13 vs. 16 mmHg; P<0.001). Postoperative graft dislocation occurred significantly more frequently in study eyes compared with control eyes (9% vs. 2%; P = 0.008). Among eyes in which dislocation occurred, postoperative hypotony was present in 5 study eyes (83%) and 0 control eyes. Conclusions: Previous glaucoma surgery was associated with a significantly increased rate of graft dislocation compared with control eyes. Dislocation was related strongly to postoperative hypotony in eyes with prior glaucoma surgery. Financial Disclosure(s): Proprietary or commercial disclosure may be found after the references. Ophthalmology 2012;119:1130-1133 (C) 2012 by the American Academy of Ophthalmology.