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Purpose-To report four cases of Descemet stripping automated endothelial keratoplasty (DSAEK) in the presence of previous glaucoma filtering surgery. Design-Observational case series.Methods-Review of clinical data of four patients who underwent DSAEK successfully performed in the presence of previous glaucoma filtering surgery with endothelial survival rates comparable with larger series previously published and good postoperative IOP control.Results-The endothelial cell loss was 36% and 39% mean cell loss at 6 months and 1 year postoperatively. The intraocular pressure remained well controlled within target levels in all patients. No complications were reported in any of the 4 cases.Conclusions-Corneal endothelial failure can be successfully managed with DSAEK in glaucoma patients with previous filtering surgery with good endothelial survival rates and good IOP control. KeywordsDSAEK; endothelial failure; glaucoma Descemet stripping automated endothelial keratoplasty (DSAEK) has recently gained popularity as the procedure of choice in the management of corneal endothelial disease. The advantages of DSAEK over penetrating keratoplasty (PK) include the avoidance of open sky surgery, minimal induced post-surgical astigmatism and faster visual rehabilitation (1,2). Theoretically, DSAEK performed in patients with history of previous filtering procedures may reduce the rate of intraoperative complications previously reported after conventional PK. However the presence of a fistula in these eyes may not allow the intraocular pressure (IOP) to reach the level necessary to achieve attachment of the donor graft to the posterior corneal surface. We describe four cases of DSAEK successfully performed in the presence of previous glaucoma filtering surgery with endothelial survival rates comparable with larger series previously published (4,5) and good postoperative IOP control.Correspondence: Salomon Esquenazi MD, LSU Eye and Neuroscience Center, 2020 Gravier Street, Suite D, 8th Floor, New Orleans, LA 70112, Phone: 305-733-9799, sesque@lsuhsc.edu. The authors have no financial interest in any product mentioned in this manuscript. Both authors had full access to all data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. NIH Public Access Report of CasesAll patients presenting to our institution with pseudophakic bullous keratopathy in the presence of normal IOP following glaucoma surgery were included. Average age was 67 years. Previous glaucoma surgery included trabeculectomy (1 case) and glaucoma shunts (3 cases). All patients were pseudophakic. Surgery was uneventful and graft attachment was achieved in all cases. Postoperatively IOP remained within target levels in all cases with antiglaucoma topical treatment required in 2 cases. No postoperative complications were observed particularly early hypotony or graft dislocations. Table 1 illustrates the preoperative data and the 6 month and 12 month IOP values and endothelial cell density (ECD) for each patien...

A prospective study was conducted on 15 consecutive keratoconic eyes to evaluate the use of grafts smaller than the opening in keratoconic myopia and astigmatism. All surgeries were performed by the senior author. Average age of the patients was 41.1 years. Average follow-up was 1.6 years. After all sutures were removed, results showed an average decrease in myopia of 13.24 diopters (D) (range 1.75 to 23.25) principally from corneal flattening and a small reduction in axial length. Average postoperative spherical equivalent was -2.17 D (range +1.50 to -7.25). The average postoperative astigmatism was 3.78 D (range 1.75 to 6.00). This study and a previous retrospective study suggest that the use of grafts 0.25 mm smaller than the opening, i.e., 7.50/7.75 mm, for penetrating keratoplasty in keratoconus is justified.

To the best of our knowledge, this is the first report of an eye-threatening complication associated with amniotic membrane grafting. Caution should be exercised in utilizing amniotic membrane in patients who have undergone multiple ophthalmologic surgical procedures, which may sensitize the ocular immune system or lead to localized ischemia.