Precautions may help prevent glaucoma after DMEK
PRAGUE Glaucoma after Descemet's membrane endothelial keratoplasty may be avoided by reducing the residual postoperative air bubble to 30% in phakic eyes, adopting a population-specific steroid regimen and avoiding graft decentration, according to a study presented here.
"Glaucoma has always been a problem with corneal transplantation, occurring 30% of the time after PK and 15% to 35% of the time after DSEK. After DMEK it might occur as a consequence of the air bubble that is kept in the eye to help the graft attach," Jack Parker, MD, said at the winter meeting of the European Society of Cataract and Refractive Surgeons.
In a study carried out at the Netherlands Institute for Innovative Ocular Surgery, the incidence of glaucoma was evaluated in the first 275 consecutive eyes that underwent DMEK, mostly for Fuchs' dystrophy. A total of 28 eyes had a history of glaucoma, of which seven (25%) developed IOP problems after surgery.
"These eyes obviously require special surveillance and special care in the administration of steroids," Dr. Parker said.
Of the eyes with no history of glaucoma, 11 (4.5%) experienced pressure problems after surgery.
"Of these 11 cases, six were phakic eyes that had mechanical angle closure due to the air bubble pressing against the iris, which in turn pressed against the lens, which squeezed the angle. In another case, the DMEK graft was decentered and rested against the iris, causing anterior synechia," Dr. Parker said.
All patients still achieved 20/25 or better vision and controlled glaucoma after the necessary interventions, Dr. Parker noted.
- Disclosure: Dr. Parker has no relevant financial disclosures.