Comparison of Endothelial Keratoplasty Techniques in Patients With Prior Glaucoma Surgery: A Case-Matched Study.

Abstract

PURPOSE:

To compare the outcomes of Descemet membrane endothelial keratoplasty (DMEK) with those of Descemet's stripping endothelial keratoplasty (DSEK) in eyes with prior glaucoma surgery.

DESIGN:

Case-matched retrospective comparative case series.

METHODS:

Setting/study population: 46 DMEK procedures were matched with 46 DSEK procedures at a single institution.

OBSERVATION PROCEDURES:

cases were matched based on preoperative visual acuity, lens status, and surgical indication.

MAIN OUTCOME MEASUREMENTS:

the outcome measurements included visual acuity improvement, primary and secondary graft failure, endothelial rejection, intraocular pressure (IOP) elevation, and the need for additional glaucoma intervention.

RESULTS:

Best-corrected visual acuity (BCVA) improved by -0.89 logMAR in the DMEK group and -0.62 logMAR in the DSEK group (P = 0.005) at 1 year follow-up. Visual acuity was significantly better in the DMEK group at postoperative months 1, 3, and 12 and at last follow-up. The percentage of patients achieving 20/40 or better best-corrected visual acuity was higher in the DMEK group at all time points, notably 47% in the DMEK group versus 15% in the DSEK group at 1 year (P = 0.002). Secondary graft failure was lower in the DMEK group (DMEK 0% vs. DSEK 17%; P = 0.006). Primary graft failure rates and rebubling rates were similar. There were no differences in the rates of postoperative IOP elevation or in the need for additional glaucoma intervention.

CONCLUSIONS:

In complex eyes with prior glaucoma surgery, DMEK offers faster visual recovery, better final visual acuity, and a lower rate of secondary graft failure compared to DSEK during the first postoperative year and beyond.

• Authors: Shawn R Lin, Pitchaya Prapaipanich, Fei Yu, Simon K Law, Joseph Caprioli, Anthony J Aldave, Sophie X Deng
• Journal: American journal of ophthalmology (Am J Ophthalmol) Vol. 206 Pg. 94-101 (10 2019) ISSN: 1879-1891 [Electronic] United States
• PMID: 30935848 (Publication Type: Comparative Study, Journal Article, Research Support, N.I.H., Extramural, Research Support, Non-U.S. Gov't)
• Copyright: Copyright © 2019. Published by Elsevier Inc.

Topics

• Aged
• Corneal Diseases (complications, diagnosis, surgery)
• Corneal Topography
• Descemet Stripping Endothelial Keratoplasty (methods)
• Female
• Filtering Surgery (methods)
• Follow-Up Studies
• Glaucoma (complications, surgery)
• Graft Rejection (diagnosis, epidemiology)
• Graft Survival
• Humans
• Incidence
• Male
• Prognosis
• Reoperation
• Retrospective Studies
• United States (epidemiology)
• Visual Acuity