PURPOSE: To evaluate 4-year outcomes of Descemet membrane endothelial keratoplasty (DMEK) in eyes with prior glaucoma surgery. DESIGN: Retrospective, comparative case series METHODS: Patients with prior trabeculectomy or glaucoma-drainage-device (GDD) implantation, who later underwent DMEK (study group) were matched for follow-up duration with Fuch's dystrophy DMEK patients (control group). Minimum follow-up was 18 months. Primary outcomes: graft survival and rejection rates. SECONDARY OUTCOMES: rates of detachment/rebubble, endothelial cell loss, best spectacle-corrected visual acuity, intraocular pressure and glaucoma medications/surgeries. Sub-group analysis compared eyes with and without a GDD. RESULTS: Ninety-four eyes of 91 patients were included. Fifty-one eyes of 49 patients in the study group (GDD=32 eyes, No GDD=19 eyes) and 43 eyes of 42 patients in the control group. Mean follow-up was 37.9±15.2 and 33.8±13.5 months, respectively (p=0.322). Graft-survival probability of the study group at 12, 24, 36, and 48 months was 75%, 60%, 43% and 27%, respectively, compared with a consistent 88% in the control group (p<0.001). Survival curves of study sub-groups (GDD and No GDD) were significantly lower than the control group (p<0.001). Rejection rates in the study and control groups were 19.6% and 2.3%, respectively (p=0.010). Endothelial cell-loss in the study group was 12-22% higher than the control group at 12, 24, 36 and 48 months (p=0.049, p=0.027, p=0.200 and p=0.004). CONCLUSIONS: In eyes with prior glaucoma surgery, DMEK has good early outcomes but longer-term rejection and failure rates are high. Physicians and patients should be cognisant of the high likelihood of graft failure in this setting.
PURPOSE: To evaluate 4-year outcomes of Descemet membrane endothelial keratoplasty (DMEK) in eyes with prior glaucoma surgery. DESIGN: Retrospective, comparative case series METHODS:Patients with prior trabeculectomy or glaucoma-drainage-device (GDD) implantation, who later underwent DMEK (study group) were matched for follow-up duration with Fuch's dystrophy DMEK patients (control group). Minimum follow-up was 18 months. Primary outcomes: graft survival and rejection rates. SECONDARY OUTCOMES: rates of detachment/rebubble, endothelial cell loss, best spectacle-corrected visual acuity, intraocular pressure and glaucoma medications/surgeries. Sub-group analysis compared eyes with and without a GDD. RESULTS: Ninety-four eyes of 91 patients were included. Fifty-one eyes of 49 patients in the study group (GDD=32 eyes, No GDD=19 eyes) and 43 eyes of 42 patients in the control group. Mean follow-up was 37.9±15.2 and 33.8±13.5 months, respectively (p=0.322). Graft-survival probability of the study group at 12, 24, 36, and 48 months was 75%, 60%, 43% and 27%, respectively, compared with a consistent 88% in the control group (p<0.001). Survival curves of study sub-groups (GDD and No GDD) were significantly lower than the control group (p<0.001). Rejection rates in the study and control groups were 19.6% and 2.3%, respectively (p=0.010). Endothelial cell-loss in the study group was 12-22% higher than the control group at 12, 24, 36 and 48 months (p=0.049, p=0.027, p=0.200 and p=0.004). CONCLUSIONS: In eyes with prior glaucoma surgery, DMEK has good early outcomes but longer-term rejection and failure rates are high. Physicians and patients should be cognisant of the high likelihood of graft failure in this setting.
Authors: Silvia Schrittenlocher; C Grass; T Dietlein; A Lappas; M Matthaei; C Cursiefen; B Bachmann Journal: Graefes Arch Clin Exp Ophthalmol Date: 2021-12-04 Impact factor: 3.117