Nonpenetrating Deep Sclerectomy For Glaucoma After Descemet Stripping Automated Endothelial Keratoplasty

Abstract

The purpose of this study was to evaluate the efficacy and safety of nonpenetrating deep sclerectomy (NPDS) in 3 consecutive eyes with preexisting and uncontrolled glaucoma after Descemet stripping with automated endothelial keratoplasty (DSAEK).NPDS with intrascleral implant and topical adjunctive intraoperative mitomycin C (0.2 mg/mL 1 minute) was performed.Intraocular pressure (IOP) and number of glaucoma medication were registered before and after NPDS with at least 1-year follow-up. Intraoperative and postoperative complications were also registered.Before NPDS, IOP was 18 mm Hg in 1 patient and 32 mm Hg in the other 2 patients. Four antiglaucoma drugs were used in 2 cases and 3 in the other one. At 1 year after NPDS, all the patients had an IOP ≤18 mm Hg. Two patients required postoperative antiglaucoma medications (1 drug in 1 case and 2 drugs in the other one). Neodymium-doped yttrium aluminum garnet laser goniopuncture was needed in 2 patients and it had to be repeated in 1 of them. No complications related to NPDS were observed. A corneal graft rejection was observed 5 months after NPDS in 1 case that resolved without sequelae with intensive corticosteroid eye-drop therapy.NPDS could be a safe and successful alternative to conventional filtration surgery after DSAEK in eyes with uncontrolled glaucoma. Larger series and a longer follow-up would be necessary to set the actual role of surgery in DSAEK patients.

Mechanism and treatment of secondary glaucoma after corneal transplantation: a review

“…NPDS was as effective as trabeculectomy in controlling intraocular pressure, but its long-term survival rate of the graft after surgery was better ( 53 ). Another study using NPDS after DSAEK for glaucoma came to the same conclusion ( 55 ).…”

Xen Gel Stent as a minimally invasive option for intraocular pressure control after DSAEK: A case study

“…The authors reported that the main advantage of NPDS over trabeculectomy was the unnecessary intraoperative entry in the AC. 5 The implant of glaucoma drainage devices (GDDs) has been investigated only in post-PK eyes, for those cases a good IOP control was reported. 11,12 On one hand, GDDs reduce the risk of hypotony and AC collapse in the early post-operative period; on the other hand, a higher rate of graft failure, when comparing GDD to trabeculectomy, was registered: in particular, a 50% probability of graft failure has been reported at 2 years following Ahmed valve implantation.…”

“…2 Trabeculectomies, non-penetrating deep sclerectomies, glaucoma drainage devices, and cyclodestructive procedures have been reported in cases of glaucoma surgery following DSAEK. 2,4,5 Except from the specific cases of a post-traumatic eye with chronic intraocular inflammation 6 and a patient with ICE syndrome, 7 no cases of Xen45 Gel Stent implantation (Allergan, Dublin, Ireland) have been previously published in a primary open angle glaucoma after DSAEK.…”