E-Poster Price Vision Group & Cornea Research Foundation of America Descemet - Stripping Endothelial Keratoplasty :Survival Outcomes in Eyes with Pre-
Post on 17-Jan-2016
216 Views
Preview:
Transcript
ee--PosterPoster
Price Vision Price Vision GroupGroup&&
Cornea ResearchCornea ResearchFoundation ofFoundation of
AmericaAmerica
Descemet -Descemet -Stripping Stripping
Endothelial Endothelial Keratoplasty :Keratoplasty :
Survival Survival Outcomes in Outcomes in
Eyes with Pre-Eyes with Pre-existing existing
GlaucomaGlaucoma
Descemet-Stripping Endothelial Keratoplasty: Descemet-Stripping Endothelial Keratoplasty: Survival Outcomes in Eyes with Pre-existing Survival Outcomes in Eyes with Pre-existing
GlaucomaGlaucoma
Arundhati Anshu,MD;Marianne O. Price, PhD; Francis W. Price, MD.
Financial Disclosures: Abbott Medical Optics – A, Addition Technology – A, Alcon Laboratories – A, Allergan – A, Calhoun Vision Inc – R, Cellular Bioengineering – A, Forsight Vision 3, Inc. – A, Inspire Pharmaceuticals – A, ISTA Pharmaceuticals – A, Moria, S.A. – E, Oculus – A, OPHTEC – A, ReVital Vision – R, TearLab – R, Voisin Consulting - A
ee--PosterPoster
IntroductionIntroductionThere is complex interaction between factors influencing outcomes of
corneal transplants and glaucoma management. Glaucoma is recognized as a risk
factor for penetrating keratoplasty failure, and conversely, grafts are a risk factor
for both the development and deterioration of glaucoma. The Australian Corneal
Graft registry and several other large series have reported that glaucoma and/or
glaucoma surgery is associated with increased risk of graft failure in full thickness
corneal transplants.
Descemet stripping endothelial keratoplasty (DSEK),
has been widely adopted for the treatment of endothelial
disorders. DSEK in eyes with trabeculectomy and shunt
devices can be technically challenging and requires
technique modifications to achieve good outcomes. While
the long-term survival of PKs in these high-risk eyes is less
than favorable, the same is not known for DSEK.Price Vision Price Vision GroupGroup
&&Cornea ResearchCornea Research
Foundation ofFoundation ofAmericaAmerica
Descemet -Descemet -Stripping Stripping
Endothelial Endothelial Keratoplasty :Keratoplasty :
Survival Survival Outcomes in Outcomes in
Eyes with Pre-Eyes with Pre-existing existing
GlaucomaGlaucoma
ee--PosterPoster To evaluate long-term survival outcomes of DSEK
in eyes with pre-existing glaucoma.
Price Vision Price Vision GroupGroup&&
Cornea ResearchCornea ResearchFoundation ofFoundation of
AmericaAmerica
Descemet -Descemet -Stripping Stripping
Endothelial Endothelial Keratoplasty :Keratoplasty :
Survival Survival Outcomes in Outcomes in
Eyes with Pre-Eyes with Pre-existing existing
GlaucomaGlaucoma
PurposePurpose
ee--PosterPoster
Price Vision Price Vision GroupGroup&&
Cornea ResearchCornea ResearchFoundation ofFoundation of
AmericaAmerica
Descemet -Descemet -Stripping Stripping
Endothelial Endothelial Keratoplasty: Keratoplasty:
Survival Survival Outcomes in Outcomes in
Eyes with Pre-Eyes with Pre-existing existing
GlaucomaGlaucoma
• A retrospective interventional case series
Parameters Evaluated
• Presence or absence of pre-existing glaucoma• Type of glaucoma surgery• Graft survival in eyes with and without glaucoma• Graft survival in eyes with glaucoma surgery
Inclusion and Exclusion Criteria:
• Patients undergoing their first DSEK for endothelial dysfunction.
Materials and MethodsMaterials and Methods
• The cumulative probability of graft survival was calculated using Kaplan-Meier
survival analysis and log rank test.
ee--PosterPoster
Price Vision Price Vision GroupGroup&&
Cornea ResearchCornea ResearchFoundation ofFoundation of
AmericaAmerica
Descemet -Descemet -Stripping Stripping
Endothelial Endothelial Keratoplasty: Keratoplasty:
Survival Survival Outcomes in Outcomes in
Eyes with Pre-Eyes with Pre-existing existing
GlaucomaGlaucoma
Results Results
• N = 350 consecutive eyes• Mean age: 69 years (S.D – 12; Range – 22-94 years)• Female:Male::241:109• Pre-operative diagnosis: Fuchs endothelial dystrophy (314,
90%) and corneal edema from other causes (36, 10%)• Eyes with pre-existing glaucoma: 45 (12.5%)• Eyes with prior glaucoma surgery: 13 (Trabeculectomy – 5;
Shunt procedure – 8)
DemographicsDemographics
ee--PosterPoster
ResultsResults
Price Vision Price Vision GroupGroup&&
Cornea ResearchCornea ResearchFoundation ofFoundation of
AmericaAmerica
Descemet -Descemet -Stripping Stripping
Endothelial Endothelial Keratoplasty: Keratoplasty:
Survival Survival Outcomes in Outcomes in
Eyes with Pre-Eyes with Pre-existing existing
GlaucomaGlaucoma
•Overall, 12/335 eyes without prior glaucoma surgery failed (3.5%)
•2 of 5 eyes with a prior trabeculectomy failed (40%)
•5 of 8 eyes with a prior shunt procedure failed (63%)
Graft failure ratesGraft failure rates
ee--PosterPoster
ResultsResults
Price Vision Price Vision GroupGroup&&
Cornea ResearchCornea ResearchFoundation ofFoundation of
AmericaAmerica
Descemet -Descemet -Stripping Stripping
Endothelial Endothelial Keratoplasty :Keratoplasty :
Survival Survival Outcomes in Outcomes in
Eyes with Pre-Eyes with Pre-existing existing
GlaucomaGlaucoma
•Kaplan-Meier survival analysis showed that the overall graft survival at 1, 2, 3, 4 and 5 years was 98%, 97%, 95%, 94%, and 93% respectively.
•Graft survival in eyes with medically managed glaucoma was 100%, 96%, 96%, 91% and 91% at 1, 2, 3, 4 and 5 years respectively and this was not statistically different from eyes without pre-existing glaucoma (5-year survival 95%, P=0.48) as seen in Figure 1 below.
Graft survival –medically managed glaucomaGraft survival –medically managed glaucoma
Figure 1
ee--PosterPoster
ResultsResults
Price Vision Price Vision GroupGroup&&
Cornea ResearchCornea ResearchFoundation ofFoundation of
AmericaAmerica
Descemet -Descemet -Stripping Stripping
Endothelial Endothelial Keratoplasty : Keratoplasty :
Survival Survival Outcomes in Outcomes in
Eyes with Pre-Eyes with Pre-existing existing
GlaucomaGlaucoma
In eyes with pre-existing shunt surgery, graft survival was 100% at 1 year, 84% at 2 years, 76% at 3 years, 56% at 4 years and 30% at 5 years and this was statistically significant when compared to eyes without prior shunt surgery (5-year survival 94%, p<0.0001) as depicted in Figure 2.
Graft survival – eyes with shunt surgeryGraft survival – eyes with shunt surgery
Figure 2
ee--PosterPoster
Discussion and conclusionDiscussion and conclusion
Price Vision Price Vision GroupGroup&&
Cornea ResearchCornea ResearchFoundation ofFoundation of
AmericaAmerica
Descemet -Descemet -Stripping Stripping
Endothelial Endothelial Keratoplasty: Keratoplasty:
Survival Survival Outcomes in Outcomes in
Eyes with Pre-Eyes with Pre-existing existing
GlaucomaGlaucoma
In eyes undergoing a penetrating keratoplasty (PK), it has been well documented that glaucoma surgery affects graft survival adversely. Glaucoma surgery generally indicates more severe glaucoma and a failure of medical therapy, and issues such as anterior chamber shallowing, and increased inflammation are all prejudicial to graft survival.
Trabeculectomy is accompanied by the use of antimetabolites that are toxic to the corneal endothelium, which, combined with the known decrease in endothelial cell density after intraocular surgery, could predispose to endothelial failure. It has been demonstrated in previous studies that the blood– aqueous barrier is transiently disrupted after trabeculectomy leading to increased immune-modulatory and/or inflammatory molecules in the anterior chamber that could cause graft rejection and failure.
ee--PosterPoster
Discussion and conclusionDiscussion and conclusion
Price Vision Price Vision GroupGroup&&
Cornea ResearchCornea ResearchFoundation ofFoundation of
AmericaAmerica
Descemet -Descemet -Stripping Stripping
Endothelial Endothelial Keratoplasty :Keratoplasty :
Survival Survival Outcomes in Outcomes in
Eyes with Pre-Eyes with Pre-existing existing
GlaucomaGlaucoma
Disruption of the blood–aqueous barrier is also produced by tube-shunt devices, and this could lead to an increased rate of rejection and hence graft failure. Drainage tube implants may damage the corneal endothelium by mechanical means or by permitting retrograde entrance of inflammatory cells into the anterior chamber, and increasing the risk of rejection and hence graft failure.
The results of this study show that similar to PK, glaucoma surgery was a significantly negative predictor of graft survival in eyes undergoing DSEK, with the cumulative 5-year graft survival in eyes with prior glaucoma shunt surgery being 30% compared to 94% in eyes without prior glaucoma shunt surgery (p<0.0001).
top related