Glaucoma after DMEK may be avoidable

Issue: August 25, 2012

Glaucoma may be avoided after Descemet membrane endothelial keratoplasty by reducing the residual air bubble to 30% in phakic eyes, applying a population-specific steroid regimen and preventing graft decentration, according to a study.

Perspective from Amar Agarwal, MS, FRCS, FRCOphth

In the study, 275 consecutive eyes that underwent DMEK were evaluated for incidence of glaucoma; 260 eyes had Fuchs’ endothelial dystrophy and 15 eyes had bullous keratopathy.

Eighteen eyes (6.5%) developed glaucoma postoperatively, seven (2.5%) of which had a glaucoma exacerbation. Eleven eyes (4%) showed a de novo IOP elevation, which the authors associated with air bubble-induced mechanical angle closure, steroid response or peripheral anterior synechiae. Two eyes experienced IOP elevation without a detectable cause.

“Compared to the literature on penetrating keratoplasty and DSEK/DSAEK, our study suggests that DMEK does not come with an increased risk of uncontrolled glaucoma,” the study authors said. “Incidental cases may be related to the presence of an angle-supported (phakic) intraocular lens, or peripheral anterior synechiae formation in eyes with a decentered graft causing adhesions between the donor tissue and the iris.”

Perspective

Amar Agarwal, MS, FRCS, FRCOphth

Endothelial keratoplasty has become a huge alternative to penetrating keratoplasty. Glaucoma, which is a complication even in PK, is an even greater complication in DMEK. Regarding patients with pre-existing glaucoma, I believe that one can combine an antiglaucoma procedure with a DMEK procedure to reduce the chance of postoperative glaucoma. All in all, this is an interesting paper and it is imperative that corneal surgeons read and understand it.

Amar Agarwal, MS, FRCS, FRCOphth

OSN APAO Edition Board Member

Disclosures: Agarwal has no relevant financial disclosures.

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Sources/Disclosures

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Source:

Am J Ophthalmol. 2012;153(5):958-966.