Abstract
PurposeThis study aims to assess the results, rebubbling rate, and graft survival after Descemet membrane endothelial keratoplasty (DMEK) with regard to the number and type of previous glaucoma surgeries.MethodsThis is a clinical retrospective review of 1845 consecutive DMEK surgeries between 07/2011 and 08/2017 at the Department of Ophthalmology, University of Cologne. Sixty-six eyes were included: group 1 (eyes with previous glaucoma drainage devices (GDD); n = 27) and group 2 (eyes with previous trabeculectomy (TE); n = 39). Endothelial cell loss (ECL), central corneal thickness, graft failure, rebubbling rate, and best spectacle-corrected visual acuity (BSCVA) up to 3 years after DMEK were compared between subgroups of patients with different numbers of and the two most common types of glaucoma surgeries either GDD or TE or both.ResultsRe-DMEK rate due to secondary graft failure was 55.6% (15/27) in group 1 and 35.9% in group 2. The mean graft survival time in group 1 was 25 ± 11 months and 31.3 ± 8.6 months in group 2 (p = 0.009).ECL in surviving grafts in group 1 was 35% (n = 13) at 6 months, 36% at 12 months (n = 8), and 27% (n = 4) at 2 years postoperatively. In group 2, ECL in surviving grafts was 41% (n = 10) at 6 months, 36% (n = 9) at 12 months, and 38% (n = 8) at 2 years postoperatively. Rebubbling rate in group 1 was 18.5% (5/27) and 35.9% (14/39) in group 2 (p = 0.079).ConclusionEyes with previous GDD had no higher risk for an increased rebubbling rate but a higher risk for a re-DMEK due to secondary graft failure with a mean transplant survival time of about 2 years. Compared to eyes with preexisting glaucoma drainage device, eyes after trabeculectomy had less secondary graft failures and a longer mean graft survival rate.
Highlights
Glaucoma surgery is frequently associated with corneal endothelial decompensation [1,2,3]
Descemet membrane endothelial keratoplasty (DMEK) in glaucomatous eyes with previous glaucoma surgery is frequently challenging due to progressed corneal edema, anatomical alterations of the anterior chamber-like anterior synechiae, tube endings from glaucoma drainage devices (GDD), or large iridectomies after trabeculectomy
A total of 66 eyes after DMEK surgeries with previous glaucoma drainage device (GDD) or trabeculectomy (TE) between 09/2011 and 09/2017 at the Department of Ophthalmology, University of Cologne, Cologne, Germany, with sufficient follow-up information were included for analysis
Summary
Glaucoma surgery is frequently associated with corneal endothelial decompensation [1,2,3]. Descemet membrane endothelial keratoplasty (DMEK) has become the procedure of choice in the treatment of corneal endothelial diseases in many centers [4, 5] This procedure allows for rapid visual recovery and fewer immunological graft rejections compared. DMEK in glaucomatous eyes with previous glaucoma surgery is frequently challenging due to progressed corneal edema, anatomical alterations of the anterior chamber-like anterior synechiae, tube endings from glaucoma drainage devices (GDD), or large iridectomies after trabeculectomy. This can complicate unfolding of the graft or lead to an accelerated postoperative loss of gas from the anterior chamber resulting in an increased risk of graft detachment [11,12,13].
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