Comparison of primary graft survival following penetrating keratoplasty and Descemet's stripping endothelial keratoplasty in eyes with prior trabeculectomy

Iverson, Shawn M.; Spierer, Oriel; Papachristou, G.; Feuer, William J.; Shi, Wei; Greenfield, David S.; O’Brien, Terrence P.

doi:10.1136/bjophthalmol-2014-306547

Cited by 11 publications

(13 citation statements)

References 33 publications

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“…These present data support the hypothesis that immune reaction to the intraocular antigen in the first operated eye may cause bleb failure in the second operated eye. Indeed, corneal transplantation graft failure frequently occurs in eyes in which glaucoma filtering surgery has been performed [ 12 ],[ 13 ],[ 14 ]. It is possible that immune communication between the intraocular antigens and the subconjunctival space could cause an adverse effect on the surgical outcome of additional surgery.…”

Section: Discussionmentioning

confidence: 99%

“…Eyes in which filtering surgery, including trabeculectomy and tube-shunt surgery, have been performed are at risk for corneal transplantation graft failure [ 12 ],[ 13 ],[ 14 ]. It has been hypothesized that this may be caused by a change in immune status after the creation of a communication between the anterior chamber and the subconjunctival space [ 12 ].…”

Section: Introductionmentioning

confidence: 99%

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Comparing Trabeculectomy Outcomes between First and Second Operated Eyes: A Multicenter Study

et al. 2016

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ObjectiveTo compare surgical outcomes between the first and second operated eyes in patients who underwent trabeculectomy in both eyes.MethodsThis retrospective clinical cohort study at five clinical centers in Japan included 84 patients with open-angle glaucoma who underwent primary trabeculectomy in both eyes. The primary outcome was surgical success or failure, with failure being defined according to three criteria: <20% reduction of the preoperative intraocular pressure (IOP), or Criterion A, IOP >21 mmHg; Criterion B, IOP >18 mmHg; or Criterion C, IOP >15 mmHg. Cases of reoperation, a loss of light perception vision, or hypotony were also considered as “failures”.ResultsThere were no significant differences in success rate for any of the three criteria between the first and second operated eyes. For patients whose first trabeculectomy was successful, when the second trabeculectomy was performed ≥2 months after the first, the survival curves for all three criteria for the second trabeculectomy were significantly worse than those for patients waiting a shorter interval between trabeculectomies (Criterion A, 52.0% vs 83.6%, P = 0.0031; Criterion B, 51.5% vs 80.4%, P = 0.026; Criterion C, 51.1% vs 80.4%, P = 0.048). In multivariable analyses, a longer interval between trabeculectomies was a significant prognostic factor for surgical failure (Criterion A, P = 0.0055; Criterion B, P = 0.0023; Criterion C, P = 0.027). However, no dependency on the interval between trabeculectomies was found among patients whose first trabeculectomy failed.ConclusionsIf the first trabeculectomy is successful, a long interval before the second trabeculectomy increases the risk of surgical failure in the second eye. This result has clinical implications for developing surgical strategies for patients with bilateral glaucoma.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Comparing Trabeculectomy Outcomes between First and Second Operated Eyes: A Multicenter Study

et al. 2016

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“…DSEK has its limitations in complex cases such as in the presence of previous tube shunt procedures, trabeculectomies and previously failed DSEK or penetrating keratoplasty grafts [ 4 – 8 ]. For patients with tube shunts, the tube placement in the anterior chamber may interfere with the surgical placement of the corneal graft and allow air to escape causing possible graft detachment in the first postoperative day [ 4 ].…”

Section: Introductionmentioning

confidence: 99%

Outcomes of complex Descemet Stripping Endothelial Keratoplasty performed by cornea fellows

et al. 2018

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BackgroundA major obstacle that academic institutions face is the steep learning curve for cornea fellows initially learning to perform Descemet Stripping Endothelial Keratoplasty (DSEK). The purpose of this study is to evaluate the outcomes of complex DSEK performed by cornea fellow supervised by an attending surgeon at an academic institution.MethodsPatients who underwent a complex DSEK procedure performed by a cornea fellow during the years 2009-2013 were included. All the surgeries were supervised by the same cornea attending. All patients had a minimum follow-up of 6 months. Charts were reviewed for demographic data, intraoperative and postoperative complications and clinical outcomes. Corneal graft survival was calculated using the Kaplan-Meier analysis.ResultsFifty-seven eyes of 55 patients (mean age 77.5 ± 8.5 years) were included in the study with a mean follow-up time of 16.4 ± 15.6 months. Previous graft failure, presence of a tube and history of trabeculectomy were the leading diagnoses to define the surgery as complex. No intraoperative complications occurred. In 21.1% of cases a corneal graft detachment was documented in the first postoperative day. Mean visual acuity improved from 1.06 LogMAR (20/230) preoperatively to 0.39 LogMAR (20/50, p < 0.001) by the sixth postoperative month and to 0.52 LogMAR (20/65, p < 0.001) at the last follow-up visit. Graft failure rate was 29.8%. Kaplan-Meier analysis found a 67.2% graft survival rate at 20 months.ConclusionsComplex DSEK can be performed successfully with an acceptable postoperative complication rate by cornea fellows during their training period when supervised by an experienced attending.

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“…Chronic elevation of intraocular pressure compromises the corneal endothelium, leading to accelerated endothelial cell losses, and limits the prognosis and represents a risk factor for graft failure 20 , 22 , 24 ) in cases where cornea transplant has been performed.…”

Section: Discussionmentioning

confidence: 99%

“…Studies have reported that increased intraocular pressure is another risk factor for endothelial cell loss after keratoplasty, especially penetrating keratoplasty 20 , 22 , 24 . Glaucoma behaves as a predictor for corneal tissue impairment, both pre and post-transplant.…”

Section: Discussionmentioning

confidence: 99%

Clinical and epidemiological aspects of cornea transplant patients of a reference hospital

Cruz

Azevedo

Carvalho

et al. 2017

Rev. Latino-Am. Enfermagem

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Objective: clinically characterizing cornea transplant patients and their distribution according to indicated and post-operative conditions of cornea transplantation, as well as estimating the average waiting time.Method: a cross-sectional, descriptive and analytical study performed for all cornea transplants performed at a reference service (n=258). Data were analyzed using Statistical Package for the Social Sciences, version 20.0.Results: the main indicator for cornea transplant was keratoconus. The mean waiting time for the transplant was approximately 5 months and 3 weeks for elective transplants and 9 days for urgent cases. An association between the type of corneal disorder with gender, age, previous surgery, eye classification, glaucoma and anterior graft failure were found.Conclusion: keratoconus was the main indicator for cornea transplant. Factors such as age, previous corneal graft failure (retransplantation), glaucoma, cases of surgeries prior to cornea transplant (especially cataract surgery) may be related to the onset corneal endothelium disorders.

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Comparison of primary graft survival following penetrating keratoplasty and Descemet's stripping endothelial keratoplasty in eyes with prior trabeculectomy

Abstract: Eyes with prior glaucoma showed higher rates of DSEK graft failure compared with PK. Patients with prior trabeculectomy demonstrated higher and earlier corneal graft failure rates with DSEK than with PK.

Cited by 11 publications

References 33 publications

Comparing Trabeculectomy Outcomes between First and Second Operated Eyes: A Multicenter Study

Comparing Trabeculectomy Outcomes between First and Second Operated Eyes: A Multicenter Study

Outcomes of complex Descemet Stripping Endothelial Keratoplasty performed by cornea fellows

Clinical and epidemiological aspects of cornea transplant patients of a reference hospital

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