Management of endothelial decompensation because of glaucoma shunt tube touch by descemet membrane endothelial keratoplasty and tube revision

Purpose: To describe the trimming of a glaucoma shunt tube with Descemet membrane endothelial keratoplasty (DMEK) for the treatment of endothelial decompensation caused by tube-endothelium touch. Methods: An 84-year-old man with pseudoexfoliative glaucoma OU had endothelial decompensation because of the touch of the tube of an Ahmed glaucoma valve at the corneal endothelium OS. The best-corrected visual acuity decreased from 20/60 to counting fingers at 3 feet. The patient underwent uncomplicated trimming of the shunt tube and DMEK. Results: After surgery, the cornea became clear, and the best-corrected visual acuity improved to 20/60. The intraocular pressure remained normal (8-12 mm Hg) without antiglaucoma medications, and endothelial cell count remained stable in a follow-up of 12 months. No complications were encountered. Conclusions: Glaucoma shunt tube trimming with DMEK may be considered in cases of endothelial decompensation because of tube-endothelium touch and may replace penetrating keratoplasty and other posterior lamellar procedures for such cases. Copyright © 2011 by Lippincott Williams & Wilkins.