In patients with corneal edema and a glaucoma drainage tube placed in the AC, under what circumstances would you consider repositioning the tube in the sulcus first versus proceeding directly with endothelial keratoplasty alone?

I have a pretty low threshold to just move these tubes to the sulcus as soon as my cornea colleagues are contemplating an EK. I am not a cornea specialist, but my impression is that first grafts almost always do better than second grafts, so I want to give that first one the best chance of survival....

I agree with what's been said here previously, but specifically, I'll add that if it's early focal edema in the area of the tube, there is a chance that repositioning the tube to the sulcus alone may be enough to avoid (for at least the short term) the need for endothelial keratoplasty. Some corneas...

I almost always will trim the tube at the time of EK unless it is already short. If the tube appears close to or touching the cornea, it would be reasonable to reposition the tube further back or in the sulcus. There is some evidence that grafts do better long term with tubes in the sulcus, but furt...

As the glaucoma guy, my DMEK or DSEK docs prefer repositioning into the sulcus prior to their intervention. If the patient does not have glaucoma or their glaucoma is well controlled, their grafts tend to have shorter duration, so they want that taken care of first. I’ve been doing more primary post...