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PRECIS: Previous trabeculectomy and medical or surgical glaucoma treatment after Descemet's stripping automated endothelial keratoplasty were significantly associated with endothelial cell loss and graft failure. Pupillary block was a significant risk factor for graft failure. PURPOSE: To evaluate the long-term risk factors associated with postoperative endothelial cell loss and graft failure after Descemet's stripping automated endothelial keratoplasty (DSAEK) in Japanese eyes, with special attention to glaucoma. METHODS: This retrospective study involved 117 eyes of 110 consecutive patients with bullous keratopathy who had undergone DSAEK. The patients were classified into four groups: no glaucoma group (n=23 eyes), primary angle-closure disease (PACD) group (n=32 eyes), glaucoma group that had previously undergone trabeculectomy (n=44 eyes) (glaucoma with bleb), and glaucoma group that had not previously undergone trabeculectomy (n=18 eyes) (glaucoma without bleb). RESULTS: The cumulative 5-year graft survival rate was 82.1%. The cumulative 5-year graft survival rate among the four groups are as follows: no glaucoma (73%), PACD (100%), glaucoma with bleb (39%), and glaucoma without bleb (80%). Multivariate analysis revealed that additional glaucoma medication and glaucoma surgery after DSAEK were independent risk factors for endothelial cell loss. Conversely, glaucoma with blebs and pupillary block were independent risk factors for graft failure after DSAEK. CONCLUSION: Previous trabeculectomy and medical or surgical glaucoma treatment after DSAEK were significantly associated with endothelial cell loss and graft failure. Pupillary block was a significant risk factor for graft failure.
Department of Ophthalmology, Kanazawa University Graduate School of Medical Sciences, Kanazawa, Ishikawa 920-8641, Japan.
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