Purpose: To investigate the postoperative course of intraocular pressure (IOP) and its associated factors after Descemet stripping automated endothelial keratoplasty (DSAEK) in glaucomatous eyes.
Subjects and methods: This study included patients who had undergone DSAEK alone as the first corneal transplantation procedure for bullous keratopathy associated with glaucoma at the Kanazawa University Hospital and were postoperatively followed up for at least 3 months. The postoperative IOP course; additional IOP-lowering treatment including anti-glaucoma medications; surgery for glaucoma after DSAEK; and their associated factors were investigated.
Results: In total, 83 eyes of 77 patients were included in this study. Age at the surgery was 74.6±9.3 [mean±standard deviation (SD)] years, the follow-up period was 40.3±28.2 months, and preoperative IOP was 11.1±4.1 mmHg. A persistent IOP increase was observed for 2 years after DSAEK. Postoperatively, 39.1% of the patients required additional IOP-lowering treatment during the 2 years. Multivariate analyses revealed that female sex, low preoperative IOP, history of trabeculotomy, no history of pars plana vitrectomy, glaucoma treated only by medication, and late graft failure were factors significantly associated with an increase in IOP within a year after DSAEK. High preoperative IOP, younger age, exfoliation glaucoma, and history of trabeculotomy were risk factors for additional IOP-lowering treatment.
Conclusions: IOP was found to have significantly increased after DSAEK in glaucomatous eyes, and many such eyes required IOP-lowering treatment. Eyes treated only by medication are prone to postoperative increases in IOP and a history of multiple surgeries, including trabeculotomy, for glaucoma is a risk factor for additional treatment. Patients with these risk factors should be followed up carefully.
Nippon Ganka Gakkai Zasshi (J Jpn Ophthalmol Soc) 126: 448-456, 2022.