Graft failure rate and complications after Descemet membrane endothelial keratoplasty in eyes with pre-existing glaucoma

Purpose To evaluate the outcome of Descemet Membrane Endothelial Keratoplasty (DMEK) in eyes with pre-existing glaucoma. Design In this retrospective, observational case series we included data of 150 consecutive DMEKs in eyes with pre-existing glaucoma of 150 patients after excluding data of the se...

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Published in:Graefe's archive for clinical and experimental ophthalmology 2023-02, Vol.261 (2), p.467-476
Main Authors: Maier, Anna-Karina B., Pilger, Daniel, Gundlach, Enken, Winterhalter, Sibylle, Torun, Necip, Dietrich-Ntoukas, Tina
Format: Article
Language:English
Subjects:
Complications
Cornea
Corneal transplantation
Descemet Membrane
Descemet Stripping Endothelial Keratoplasty - adverse effects
Dystrophy
Endothelium, Corneal
Eye
Eye surgery
Follow-Up Studies
Fuchs' Endothelial Dystrophy - complications
Fuchs' Endothelial Dystrophy - surgery
Glaucoma
Glaucoma - etiology
Glaucoma - surgery
Graft rejection
Graft Survival
Grafts
Humans
Medicine
Medicine & Public Health
Ophthalmology
Postoperative
Retrospective Studies
Risk factors
Surgery
Survival analysis
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Summary:Purpose To evaluate the outcome of Descemet Membrane Endothelial Keratoplasty (DMEK) in eyes with pre-existing glaucoma. Design In this retrospective, observational case series we included data of 150 consecutive DMEKs in eyes with pre-existing glaucoma of 150 patients after excluding data of the second treated eye of each patient and of re-DMEKs during follow-up. Cumulative incidences of IOP elevation (IOP > 21 mmHg or ≥ 10 mmHg increase in IOP from preoperative value), post-DMEK glaucoma (need of an additional intervention due to worsening of the IOP), graft rejection, and graft failure rate were analyzed using Kaplan–Meier survival analysis. COX regression analysis was used to evaluate independent risk factors. Results The 36-month cumulative incidence of IOP elevation was 53.5% [95 CI 43.5–63.5%] and of post-DMEK glaucoma 36.3% [95 CI 26.3–46.3%]. Graft rejection occurred with a 36-month cumulative incidence of 9.2% [CI 95% 2.3–16.1]. None of the analyzed risk factors increased the risk for the development of graft rejection. The 36-month cumulative incidence of graft failure was 16.6% [CI 95% 8.4–24.8]. Independent risk factors for graft failure were the indication for DMEK “status after graft failure” ( n  = 16) compared to Fuchs’ dystrophy ( n  = 74) ( p  = 0.045, HR 8.511 [CI 95% 1.054–68.756]) and pre-existing filtrating surgery via glaucoma drainage device (GDD) ( n  = 10) compared to no surgery/iridectomy ( n  = 109) ( p  = 0.014, HR 6.273 [CI 95% 1.456–27.031]). Conclusion The risks of postoperative complications (IOP elevation, post-DMEK glaucoma, graft rejection, and graft failure) in patients with pre-existing glaucoma are high. In particular, pre-existing filtrating surgery via GDD implantation—but not trabeculectomy—and DMEK after graft failure increase the risk of graft failure.
ISSN:0721-832X
1435-702X
DOI:10.1007/s00417-022-05813-4