Nonpenetrating deep sclerectomy for glaucoma after descemet stripping automated endothelial keratoplasty: three consecutive case reports

Medicine (Baltimore). 2015 Feb;94(6):e543. doi: 10.1097/MD.0000000000000543.

Abstract

The purpose of this study was to evaluate the efficacy and safety of nonpenetrating deep sclerectomy (NPDS) in 3 consecutive eyes with preexisting and uncontrolled glaucoma after Descemet stripping with automated endothelial keratoplasty (DSAEK).NPDS with intrascleral implant and topical adjunctive intraoperative mitomycin C (0.2 mg/mL 1 minute) was performed.Intraocular pressure (IOP) and number of glaucoma medication were registered before and after NPDS with at least 1-year follow-up. Intraoperative and postoperative complications were also registered.Before NPDS, IOP was 18 mm Hg in 1 patient and 32 mm Hg in the other 2 patients. Four antiglaucoma drugs were used in 2 cases and 3 in the other one. At 1 year after NPDS, all the patients had an IOP ≤18 mm Hg. Two patients required postoperative antiglaucoma medications (1 drug in 1 case and 2 drugs in the other one). Neodymium-doped yttrium aluminum garnet laser goniopuncture was needed in 2 patients and it had to be repeated in 1 of them. No complications related to NPDS were observed. A corneal graft rejection was observed 5 months after NPDS in 1 case that resolved without sequelae with intensive corticosteroid eye-drop therapy.NPDS could be a safe and successful alternative to conventional filtration surgery after DSAEK in eyes with uncontrolled glaucoma. Larger series and a longer follow-up would be necessary to set the actual role of surgery in DSAEK patients.

MeSH terms

  • Administration, Topical
  • Aged
  • Descemet Stripping Endothelial Keratoplasty*
  • Female
  • Glaucoma / drug therapy
  • Glaucoma / surgery*
  • Humans
  • Intraocular Pressure
  • Middle Aged
  • Mitomycin / administration & dosage
  • Sclerostomy / methods*

Substances

  • Mitomycin