Glaucoma-Related Risk Factors for Endothelial Cell Loss and Graft Failure After Descemet's Stripping Automated Endothelial Keratoplasty.

PRCIS: Previous trabeculectomy and medical or surgical glaucoma treatment after Descemet's stripping automated endothelial keratoplasty (DSAEK) were significantly associated with endothelial cell loss and graft failure. The 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 DSAEK in Japanese eyes, with special attention to glaucoma. PATIENTS AND METHODS: This retrospective study involved 117 eyes of 110 consecutive patients with bullous keratopathy who had undergone DSAEK. The patients were classified into 4 groups: (1) no glaucoma group (n = 23 eyes), (2) primary angle closure disease group (n = 32 eyes), (3) glaucoma group that had previously undergone trabeculectomy (n = 44 eyes) (glaucoma with bleb), and (4) 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 4 groups is as follows: no glaucoma (73%), primary angle closure disease (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.

Diurnal Variation of Corneal Hysteresis in Patients With Untreated Primary Open Angle Glaucoma and Normal Individuals.

PRCIS: Corneal hysteresis in both patients with untreated open angle glaucoma and normal individuals demonstrated significant diurnal variation independent of confounding factors and was higher in the nighttime than in the daytime. PURPOSE: To investigate diurnal variations in corneal hysteresis (CH) in patients with untreated primary open angle glaucoma (POAG) and normal individuals by using an ocular response analyzer. MATERIALS AND METHODS: This prospective study included 72 eyes of 53 patients with untreated POAG and 53 eyes of 47 normal individuals. Intraocular pressure (IOP) and CH were measured using Goldmann applanation tonometry (GAT) and ocular response analyzer, respectively, every 3 hours from 9:00 to 24:00. Mixed-effects models were used to determine factors associated with CH values and CH amplitude (maximum values minus minimum values) and to examine the diurnal variations in GAT IOP and CH in each group. Significant differences between time points were defined as significant variations. RESULTS: The diurnal average GAT IOP and CH in patients with POAG were significantly higher and lower than those in normal individuals ( P =0.001, 0.002). In the multivariate analysis, the larger central corneal thickness was associated with larger CH values in POAG and normal eyes (both P <0.001). A larger amplitude of GAT IOP was significantly associated with a larger CH amplitude in POAG and normal eyes ( P =0.010, 0.013). CH, in both groups, showed similar significant diurnal variation and was higher in the nighttime than in the daytime, even after adjusting for confounding factors, while IOP showed an antiphase pattern. CONCLUSION: CH in both untreated POAG patients and normal participants demonstrated similar diurnal variations, that is, higher at night, independent of confounding factors. These findings suggest that viscoelastic properties of the cornea may fluctuate diurnally independent of IOP.