Descemet's stripping endothelial keratoplasty: long-term graft survival and risk factors for failure in eyes with preexisting glaucoma

Ophthalmology. 2012 Oct;119(10):1982-7. doi: 10.1016/j.ophtha.2012.04.031. Epub 2012 Jun 15.


Purpose: To evaluate long-term corneal graft survival and risk factors for graft failure after Descemet's stripping endothelial keratoplasty (DSEK) in eyes with preexisting glaucoma.

Design: Retrospective case control study.

Participants: A total of 835 DSEK cases performed by a single surgeon between December 2003 and August 2007 were reviewed. Only the first treated eye of each patient with at least 1 year follow-up was included, resulting in 453 cases; 342 had no prior glaucoma (C), 65 had medically managed preexisting glaucoma (G), and 46 had prior glaucoma surgery (GS).

Methods: Corneal graft failure was defined as persistent corneal edema resulting in irreversible loss of optical clarity. Corneal graft survival in the 3 groups was calculated using Kaplan-Meier survival analysis. Nine potential risk factors for graft failure were evaluated by Cox proportional hazards univariate and multivariate analysis. These methods took length of follow-up into consideration.

Main outcome measures: Corneal graft survival and risk factors influencing long-term corneal endothelial failure.

Results: The 1-, 2-, 3-, 4-, and 5-year graft survival was 99%, 99%, 97%, 97%, and 96%, respectively, in group C; 100%, 98%, 98%, 96%, and 90%, respectively, in group G; and 96%, 91%, 84%, 69%, and 48%, respectively, in group GS (P < 0.001). In the GS group, the 5-year survival rate for eyes with a glaucoma drainage device (GDD) and those with trabeculectomy only was 25% and 59%, respectively. Indication for DSEK, surgically managed glaucoma, type and number of prior glaucoma surgeries, and occurrence of a rejection episode were the significant risk factors for graft survival in univariate analysis. Several factors were correlated; in a multivariate model, prior glaucoma surgery (P < 0.0001) and a prior rejection episode (0.0023) were the significant risk factors for corneal endothelial failure.

Conclusions: Patients with medically managed glaucoma had significantly better 5-year graft survival than those with surgically managed glaucoma. A prior glaucoma shunt or trabeculectomy significantly increased the risk of DSEK endothelial failure.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Case-Control Studies
  • Corneal Diseases / surgery
  • Corneal Endothelial Cell Loss / physiopathology*
  • Descemet Stripping Endothelial Keratoplasty*
  • Endothelium, Corneal / pathology*
  • Female
  • Follow-Up Studies
  • Glaucoma / drug therapy
  • Glaucoma / physiopathology*
  • Glaucoma / surgery
  • Graft Survival / physiology*
  • Humans
  • Intraocular Pressure
  • Male
  • Middle Aged
  • Retrospective Studies
  • Risk Factors
  • Tissue Donors
  • Trabeculectomy
  • Treatment Failure
  • Young Adult