Comparison of Glaucoma Therapy Escalation After Penetrating Keratoplasty to Descemet Stripping Automated Endothelial Keratoplasty for the Treatment of Pseudophakic Bullous Keratopathy: A Cohort Study

Abstract

PURPOSE: The purpose of this study was to compare glaucoma therapy escalation (GTE), graft survival, vision, and glaucoma following penetrating keratoplasty (PK group) and Descemet stripping automated endothelial keratoplasty (DSAEK group) to treat pseudophakic bullous keratopathy (PBK). METHODS: This cohort included cases of PBK managed with PK from 2009 to 2014. We compared the incidences and determinants of GTE, graft survival, and visual disability. P < 0.05 was statistically significant. RESULTS: There were 58 eyes in the PK group and 117 eyes in the DSAEK group. The incidence of GTE in the PK and DSAEK groups at the last follow-up was 34.2% (95% confidence interval [CI]: 19.5–48.9) and 46.6% (95% CI: 27.7–65.4), respectively. The risk of GTE was similar between the groups (relative risk [RR] = 1.36 [95% CI: 0.94–1.98], P = 0.12). GTE was significantly associated with graft survival in the PK group (RR = 3.25 [95% CI: 1.5–7.0], P < 0.001) and the DSAEK group (RR = 3.77 [95% CI: 2.6–5.6], P < 0.001). Glaucoma ( P = 0.001) and previous keratoplasty ( P < 0.001) were significant predictors for GTE. At the final follow-up visit, severe visual disability was not significantly different between the groups (RR = 0.9 [95% CI: 0.3–2.9], P = 0.88). There was a statistically significant improvement in vision after DSAEK ( P < 0.001) but not after PK ( P = 0.67). CONCLUSION: GTE was similar in eyes with PBK managed by PK or DSAEK. Glaucoma and previous keratoplasty were predictors of GTE post-keratoplasty. DSAEK gave better visual outcomes than PK for managing PBK.

Descemet membrane endothelial keratoplasty and penetrating keratoplasty in pseudophakic bullous keratopathy: comparison of visual outcomes, graft survival rates, and complications

“…In a study by Sharma et al, in eyes that underwent keratoplasty with different etiologies, IOP increase occurred at a lower rate in the early period after DSEK than in PK. However, there was no significant difference in IOP between the DSEK and PK groups at the 24th week [15]. In the study comparing the glaucoma therapy escalation (GTE) after PK and DSEK in eyes with PBK, no significant difference was found between the two groups [16].…”