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A complicated anterior segment increases graft failure and dislocation in eyes undergoing Descemet’s stripping automat

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A complicated anterior segment increases graft failure and dislocation in eyes undergoing Descemet’s stripping automat - PowerPoint PPT Presentation


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A complicated anterior segment increases graft failure and dislocation in eyes undergoing Descemet’s stripping automated endothelial keratoplasty (DSAEK). Francis Char DeCroos, MD Derek W. DelMonte, MD Jessica H. Chow, MD Terry Kim, MD Alan N. Carlson, MD Natalie A. Afshari, MD

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A complicated anterior segment increases graft failure and dislocation in eyes undergoing Descemet’s stripping automated endothelial keratoplasty (DSAEK).

Francis Char DeCroos, MD

Derek W. DelMonte, MD

Jessica H. Chow, MD

Terry Kim, MD

Alan N. Carlson, MD

Natalie A. Afshari, MD

Duke Eye Center

The authors have no financial interest in the subject matter of this poster.

purpose
Purpose
  • To investigate the relationship between DSEK graft dislocation and failure in eyes with a prior diagnosis of glaucoma and a complicated anterior segment (including peripheral anterior synechiae or PAS, narrow angles, or a shallow anterior chamber).

J. J. Kanski, Clinical Ophthalmology: A Systematic Approach, 2007

hypothesis
Hypothesis
  • Challenges in glaucomatous eyes
    • Increased rate of PAS1
    • Increased rate of narrow angles or shallow AC2
    • Difficulty in obtaining appropriate AC air fill3
    • Manipulation with indwelling shunt
    • 1.8X chance of increased rejection4

1. Lee, Kor J Ophthalmol, 2006. 2. Bonomi, Ophthalmol, 2000;3. Ide, Open Ophthal J, 2009; 4. Price, Br J Ophthalmol, 2009.

methods
Methods
  • Retrospective case-control study
  • Cases: Prior diagnosis of glaucoma
    • No history of incisional glaucoma surgery
    • Prior trabeculectomy and/or aqueous shunt(s)
  • Controls: No prior diagnosis of glaucoma
  • Include only first DSAEK in any eye
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BCVA

*p<0.05 at all evaluated time points

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IOP

*p<0.05 at 180 day time point only

glaucoma subgroup analysis
Glaucoma Subgroup Analysis

Glaucoma

n = 96

Uncomplicated Anterior Segment

n = 69

Complex Anterior Segment

n= 27

PAS

n = 8

Narrow Angle or Shallow AC

n = 7

PAS + Narrow Angle or Shallow AC

n = 12

conclusions
Conclusions
  • Complex Anterior Segment
    • Risk factor for graft dislocation
    • Risk factor for graft failure
    • Should prompt meticulous post operative surveillance