Graft dislocation and hypotony after Descemet's stripping automated endothelial keratoplasty in patients with previous glaucoma surgery

Ophthalmology. 2012 Jun;119(6):1130-3. doi: 10.1016/j.ophtha.2012.01.012. Epub 2012 Mar 3.


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 μm; 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.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Descemet Stripping Endothelial Keratoplasty*
  • Female
  • Glaucoma / surgery*
  • Glaucoma Drainage Implants
  • Humans
  • Intraocular Pressure*
  • Male
  • Middle Aged
  • Ocular Hypotension / etiology*
  • Postoperative Complications*
  • Primary Graft Dysfunction / etiology*
  • Retrospective Studies
  • Risk Factors
  • Trabeculectomy