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

Shawn M. Iverson, Oriel Spierer, George C. Papachristou, William J. Feuer, Wei Shi, David S. Greenfield, Terrence P. O'Brien

Research output: Contribution to journalArticle

7 Citations (Scopus)

Abstract

Purpose To compare corneal graft survival rate after primary Descemet's stripping endothelial keratoplasty (DSEK) and primary penetrating keratoplasty (PK) in patients with prior trabeculectomy or medically managed glaucoma. Methods A retrospective chart review was conducted on consecutive patients who underwent DSEK or PK. Inclusion criteria consisted of eyes with a diagnosis of glaucoma prior to corneal transplantation and ?6 months of follow-up. Graft failure was defined as an oedematous cornea with failure to maintain deturgescence lasting beyond a period of 1 month of intense steroid therapy or vascularisation and scarring resulting in irreversible loss of central graft clarity. Corneal graft survival was calculated using Kaplan-Meier survival analysis. Patients were divided into four groups: trabeculectomy-DSEK, trabeculectomy-PK, medical-DSEK or medical-PK. Results Fifty eyes (30 DSEK, 20 PK) of 50 patients (mean age 7710 years) met the enrolment criteria. Mean follow-up was 17.414.2 months. A significantly higher proportion of the DSEK grafts (50%) compared with PK grafts (10%) failed at last follow-up (p=0.005). Kaplan-Meier analysis identified a significant difference between the groups with respect to time to graft failure (p=0.006). Patients with trabeculectomy who underwent DSEK had earlier graft failures than all other groups (p?0.035), but there were no differences between the medical-DSEK, medical-PK and trabeculectomy-PK groups (all p>0.35). Conclusions 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.

Original languageEnglish (US)
Pages (from-to)1477-1482
Number of pages6
JournalBritish Journal of Ophthalmology
Volume99
Issue number11
DOIs
StatePublished - Nov 2015

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Descemet Stripping Endothelial Keratoplasty
Penetrating Keratoplasty
Trabeculectomy
Graft Survival
Transplants
Glaucoma
Kaplan-Meier Estimate
Corneal Transplantation
Survival Analysis
Cornea
Cicatrix
Survival Rate

All Science Journal Classification (ASJC) codes

  • Ophthalmology
  • Sensory Systems
  • Cellular and Molecular Neuroscience

Cite this

Iverson, Shawn M. ; Spierer, Oriel ; Papachristou, George C. ; Feuer, William J. ; Shi, Wei ; Greenfield, David S. ; O'Brien, Terrence P. / Comparison of primary graft survival following penetrating keratoplasty and Descemet's stripping endothelial keratoplasty in eyes with prior trabeculectomy. In: British Journal of Ophthalmology. 2015 ; Vol. 99, No. 11. pp. 1477-1482.
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title = "Comparison of primary graft survival following penetrating keratoplasty and Descemet's stripping endothelial keratoplasty in eyes with prior trabeculectomy",
abstract = "Purpose To compare corneal graft survival rate after primary Descemet's stripping endothelial keratoplasty (DSEK) and primary penetrating keratoplasty (PK) in patients with prior trabeculectomy or medically managed glaucoma. Methods A retrospective chart review was conducted on consecutive patients who underwent DSEK or PK. Inclusion criteria consisted of eyes with a diagnosis of glaucoma prior to corneal transplantation and ?6 months of follow-up. Graft failure was defined as an oedematous cornea with failure to maintain deturgescence lasting beyond a period of 1 month of intense steroid therapy or vascularisation and scarring resulting in irreversible loss of central graft clarity. Corneal graft survival was calculated using Kaplan-Meier survival analysis. Patients were divided into four groups: trabeculectomy-DSEK, trabeculectomy-PK, medical-DSEK or medical-PK. Results Fifty eyes (30 DSEK, 20 PK) of 50 patients (mean age 7710 years) met the enrolment criteria. Mean follow-up was 17.414.2 months. A significantly higher proportion of the DSEK grafts (50{\%}) compared with PK grafts (10{\%}) failed at last follow-up (p=0.005). Kaplan-Meier analysis identified a significant difference between the groups with respect to time to graft failure (p=0.006). Patients with trabeculectomy who underwent DSEK had earlier graft failures than all other groups (p?0.035), but there were no differences between the medical-DSEK, medical-PK and trabeculectomy-PK groups (all p>0.35). Conclusions 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.",
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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, George C.; Feuer, William J.; Shi, Wei; Greenfield, David S.; O'Brien, Terrence P.

In: British Journal of Ophthalmology, Vol. 99, No. 11, 11.2015, p. 1477-1482.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Comparison of primary graft survival following penetrating keratoplasty and Descemet's stripping endothelial keratoplasty in eyes with prior trabeculectomy

AU - Iverson, Shawn M.

AU - Spierer, Oriel

AU - Papachristou, George C.

AU - Feuer, William J.

AU - Shi, Wei

AU - Greenfield, David S.

AU - O'Brien, Terrence P.

PY - 2015/11

Y1 - 2015/11

N2 - Purpose To compare corneal graft survival rate after primary Descemet's stripping endothelial keratoplasty (DSEK) and primary penetrating keratoplasty (PK) in patients with prior trabeculectomy or medically managed glaucoma. Methods A retrospective chart review was conducted on consecutive patients who underwent DSEK or PK. Inclusion criteria consisted of eyes with a diagnosis of glaucoma prior to corneal transplantation and ?6 months of follow-up. Graft failure was defined as an oedematous cornea with failure to maintain deturgescence lasting beyond a period of 1 month of intense steroid therapy or vascularisation and scarring resulting in irreversible loss of central graft clarity. Corneal graft survival was calculated using Kaplan-Meier survival analysis. Patients were divided into four groups: trabeculectomy-DSEK, trabeculectomy-PK, medical-DSEK or medical-PK. Results Fifty eyes (30 DSEK, 20 PK) of 50 patients (mean age 7710 years) met the enrolment criteria. Mean follow-up was 17.414.2 months. A significantly higher proportion of the DSEK grafts (50%) compared with PK grafts (10%) failed at last follow-up (p=0.005). Kaplan-Meier analysis identified a significant difference between the groups with respect to time to graft failure (p=0.006). Patients with trabeculectomy who underwent DSEK had earlier graft failures than all other groups (p?0.035), but there were no differences between the medical-DSEK, medical-PK and trabeculectomy-PK groups (all p>0.35). Conclusions 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.

AB - Purpose To compare corneal graft survival rate after primary Descemet's stripping endothelial keratoplasty (DSEK) and primary penetrating keratoplasty (PK) in patients with prior trabeculectomy or medically managed glaucoma. Methods A retrospective chart review was conducted on consecutive patients who underwent DSEK or PK. Inclusion criteria consisted of eyes with a diagnosis of glaucoma prior to corneal transplantation and ?6 months of follow-up. Graft failure was defined as an oedematous cornea with failure to maintain deturgescence lasting beyond a period of 1 month of intense steroid therapy or vascularisation and scarring resulting in irreversible loss of central graft clarity. Corneal graft survival was calculated using Kaplan-Meier survival analysis. Patients were divided into four groups: trabeculectomy-DSEK, trabeculectomy-PK, medical-DSEK or medical-PK. Results Fifty eyes (30 DSEK, 20 PK) of 50 patients (mean age 7710 years) met the enrolment criteria. Mean follow-up was 17.414.2 months. A significantly higher proportion of the DSEK grafts (50%) compared with PK grafts (10%) failed at last follow-up (p=0.005). Kaplan-Meier analysis identified a significant difference between the groups with respect to time to graft failure (p=0.006). Patients with trabeculectomy who underwent DSEK had earlier graft failures than all other groups (p?0.035), but there were no differences between the medical-DSEK, medical-PK and trabeculectomy-PK groups (all p>0.35). Conclusions 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.

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