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Abstract #90201 Published in IGR 21-3
Four-Year Survival of Descemet Membrane Endothelial Keratoplasty in Patients With Previous Glaucoma Surgery
Sorkin N; Mimouni M; Kisilevsky E; Boutin T; Cohen E; Trinh T; Santaella G; Slomovic AR; Chan CC; Rootman DSAmerican Journal of Ophthalmology 2020; 218: 7-16
PURPOSE: To evaluate 4-year outcomes of Descemet membrane endothelial keratoplasty (DMEK) in eyes with previous glaucoma surgery. DESIGN: Retrospective, comparative case series. METHODS: Patients with previous trabeculectomy or glaucoma drainage device (GDD) implantation who later underwent DMEK (study group) were matched for follow-up duration with Fuchs dystrophy DMEK patients (control group). The minimum follow-up was 18 months. Primary outcomes included graft survival and rejection rates, and secondary outcomes included rates of detachment/rebubble, endothelial cell loss, best spectacle-corrected visual acuity, intraocular pressure, and glaucoma medications/surgeries. Subgroup analysis compared eyes with and without a GDD. RESULTS: Ninety-four eyes of 91 patients were included. There were 51 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. The mean follow-up was 37.9 ± 15.2 and 33.8 ± 13.5 months, respectively (P = .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 < .001). Survival curves of study subgroups (GDD and no GDD) were significantly lower than the control group (P < .001). Rejection rates in the study and control groups were 19.6% and 2.3%, respectively (P = .010). Endothelial cell loss in the study group was 12%-22% higher than the control group at 12, 24, 36, and 48 months (P = .049, P = .027, P = .200, and P = .004). CONCLUSIONS: In eyes with previous glaucoma surgery, DMEK has good early outcomes, but longer-term rejection and failure rates are high. Physicians and patients should be cognizant of the high likelihood of graft failure in this setting.
Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada. Electronic address: nir.sorkin@gmail.com.
Full articleClassification:
9.4.11.4 Glaucomas associated with corneal surgery (Part of: 9 Clinical forms of glaucomas > 9.4 Glaucomas associated with other ocular and systemic disorders > 9.4.11 Glaucomas following intraocular surgery)
12.8.1 Without tube implant (Part of: 12 Surgical treatment > 12.8 Filtering surgery)
12.8.2 With tube implant or other drainage devices (Part of: 12 Surgical treatment > 12.8 Filtering surgery)
9.4.2.3 Fuchs' endothelial dystrophy (Part of: 9 Clinical forms of glaucomas > 9.4 Glaucomas associated with other ocular and systemic disorders > 9.4.2 Glaucomas associated with disorders of the cornea, conjunctiva, sclera)
