Session Title: Cornea
Session Date/Time: Sunday 05/02/2012 | 08:30-11:00
Paper Time: 09:52
Venue: Hall 1
First Author: : J.Parker UNITED STATES
Co Author(s): : M. Naveiras M. Dirisamer L. Ham K. van Dijk I. Dapena G. Melles
Purpose:
To describe the incidence and causes of glaucoma after Descemet membrane endothelial keratoplasty (DMEK).
Setting:
Non-randomized, prospective clinical study, at a tertiary referral center. Netherlands Institute for Innovative Ocular Surgery, Rotterdam.
Methods:
The incidence of glaucoma was evaluated in the first 275 consecutive eyes that underwent DMEK for Fuchs endothelial dystrophy (260 eyes) or bullous keratopathy (15 eyes). Glaucoma was defined as a postoperative intraocular pressure (IOP) elevation of ≥24 mmHg, or ≥10 mmHg from the preoperative baseline. If possible, the cause of glaucoma was identified, and best corrected visual acuity (BCVA), endothelial cell density (ECD), and postoperative course were documented, with a mean follow-up of 22 (±13) months. RESULTS Overall, 18 eyes (6.5%) showed postoperative glaucoma after DMEK. Seven eyes (2.5%) had an exacerbation of a pre-existing glaucoma. Eleven eyes (4%) presented with a ‘de-novo’ IOP elevation, associated with air bubble induced mechanical angle closure (2%), steroid response (0.7%), peripheral anterior synechiae (0.4%), or without detectable cause (0.7%). Two eyes (0.7%) required glaucoma surgery after DMEK. At six months, all eyes had a BCVA of ≥20/40 (≥0.5), and 81% reached ≥20/25 (≥0.8) (n=16); mean ECD was 1660 (±554) cells/mm2 (n=15) (P>0.1).
Conclusions:
Glaucoma after DMEK may be a relatively frequent complication, that could be avoided by reducing the residual postoperative air bubble to 30% in phakic eyes, a population specific steroid regime, and avoiding decentration of the Descemet graft. Eyes with a history of glaucoma may need close IOP monitoring in the first postoperative months, especially in eyes with an angle supported phakic intraocular lens.
Financial Disclosure:
No
