Long-term Results of Intraocular Pressure Elevation and Post-DMEK Glaucoma After Descemet Membrane Endothelial Keratoplasty. Issue 1 (January 2021)

• Record Type: Journal Article
• Authors: Maier, Anna-Karina B.; Pilger, Daniel; Gundlach, Enken; Winterhalter, Sibylle; Torun, Necip
• Is Part Of: Cornea. Volume 40:Issue 1(2021)
• Publication Date: 2021-01
• Subjects: DMEK -- intraocular pressure elevation -- post-DMEK glaucoma -- post-keratoplasty glaucoma; Cornea -- Periodicals; Cornea -- Periodicals; Cornée -- Périodiques; 617.719
• DOI: 10.1097/ICO.0000000000002363
• Languages: English
• ISSNs: 0277-3740

Abstract

Abstract : Purpose: Intraocular pressure (IOP) elevation occurs regularly after Descemet membrane endothelial keratoplasty (DMEK). This study evaluated the long-term incidence of IOP elevation and post-DMEK glaucoma after DMEK. Methods: A total of 463 consecutive DMEKs in 352 patients performed between September 2011 and September 2014 at the Universitätsmedizin-Charité Berlin were reviewed. Data of the second treated eye of each patient and of re-DMEKs during the follow-up were excluded. The 12- and 36-month incidence of IOP elevation and post-DMEK glaucoma was analyzed using the Kaplan–Meier survival analysis. IOP elevation was defined as IOP ≥22 mm Hg or ≥10 mm Hg from preoperative baseline. COX regression analysis was used to evaluate the risk factors for IOP elevation and the development of a post-DMEK glaucoma. Results: The 12-month incidence of IOP elevation was 15.9% [95 confidence interval (CI), 12.0%–19.8%] and that of post-DMEK glaucoma was 3.9% (95 CI, 1.7%–6.1%); the 36-month incidence was 18.8% (95 CI, 14.5%–23.1%) and that of post-DMEK glaucoma was 6.6% (95 CI, 3.7%–9.5%). The most frequent cause was steroid-induced IOP elevation with a 12-month incidence of 11.7% (95 CI, 8.2%–15.2%) and a 36-month incidence of 12.9% (95 CI, 9.2%–16.6%), respectively. The incidence of postoperative pupillary block IOP elevation was 7.5% (95 CI, 4.8%–10.2%). A preexisting glaucoma increased the risk of IOP elevation [ P < 0.001, hazard ratio (HR) 3.331; 95% CI, 1.919–5.782] and the development of a post-DMEK glaucoma ( P < 0.001, HR 6.633; 95% CI, 2.556–17.215). The preoperative diagnosis also influenced the risk of IOP elevation [Fuchs corneal dystrophy (FED) vs. bullous keratopathy; P = 0.012, HR 2.354; 95% CI, 1.203–4.608] and post-DMEK glaucoma (FED vs. graft failure; P = 0.01, HR 4.412; 95% CI, 1.419–13.723, FED vs. bullous keratopathy; P = 0.09, HR 2.679; 95% CI, 0.858–8.358). Conclusions: Incidence of IOP elevation is high in the first 12 months after DMEK, especially steroid-induced IOP elevation. Steroid-induced IOP elevation could be treated effectively by tapering down the steroid medication or changing the steroid drug. A preexisting glaucoma and the preoperative diagnosis increase the risk for an IOP elevation and a post-DMEK glaucoma.