Clinical Outcomes of Descemet Membrane Endothelial Keratoplasty in Eyes With a Glaucoma Drainage Device

Abstract

To evaluate the feasibility and clinical outcomes of Descemet membrane endothelial keratoplasty (DMEK) in eyes with a glaucoma drainage device (GDD). Retrospective, interventional case series. Clinical outcomes of 23 DMEK procedures for bullous keratopathy (52%), failed previous transplant (39%), or Fuchs endothelial corneal dystrophy (9%) in 20 eyes (19 patients) with a GDD were retrospectively analyzed at 2 tertiary referral centers. Main outcome measures were best-corrected visual acuity (BCVA), endothelial cell density (ECD), postoperative complications, and graft survival. Mean length of postoperative follow-up after DMEK was 19 (±17) months. Kaplan-Meier survival analysis showed an 89% cumulative graft success rate at 1 year postoperatively. At 1 year postoperatively (n= 15 eyes), BCVA improved by ≥2 Snellen lines in 11 eyes (73%) and remained stable in 4 eyes (27%). Donor ECD decreased by 37% (n= 14), 60% (n=11), and 71% (n= 11) at 1, 6, and 12months postoperatively, respectively. Postoperative complications up to 2 years postoperatively comprised pupillary block in 1 eye (successfully reversed by partial air removal), visually significant graft detachment requiring rebubbling in 5 eyes (22%), allograft rejection successfully reversed with topical steroids in 2 eyes (9%), secondary graft failure in 2 eyes (9%), and cataract in 1 of 3 phakic eyes (33%). Re-keratoplasty was required in 2 eyes (9%). With specific surgical modifications, DMEK provided acceptable clinical outcomes when taking the complexity of these eyes into account. However, presence of a GDD may reduce graft survival times and may pose a risk for more frequent regrafting.