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Tisha Prabriputaloong Stanzel, Wiwan Sansanayudh, Claus Cursiefen; Immediate and early postoperative intraocular pressure measurements after Descemet’s Membrane Endothelial Keratoplasty (DMEK). Invest. Ophthalmol. Vis. Sci. 2014;55(13):876.
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To compare intraocular pressure (IOP) before, immediately and early after intracameral air injection in DMEK patients.
All consecutive patients in a one week period undergoing DMEK surgery at the Department of Ophthalmology at the University of Cologne, Germany were included (n=11). The IOP was measured preoperatively, at 0, 1, 2, 3, 5, 12, 24 hours, 1 week and 1 month following the surgery. Preoperative and 1 month postoperative visual acuity were collected. IOP was measured using indentation (Schioetz), applanation (Goldmann) and rebound tonometry (ICARE).
During September 9 to 13, 2013, there were 11 patients, 5 female and 6 male, undergoing DMEK-related procedures; 6 DMEK, 2 triple-DMEK and 3 rebubbling procedures. Four cases were excluded due to either intraoperative hyphema (DMEK), combined goniosynechiolysis with rebubbling, incompleted IOP data (triple-DMEK) and postoperative bandage contact lens interfering with IOP measurement (DMEK). Mean age was 68 years (range 56-83). No patient had pre-existing glaucoma. Three out of 8 patients required the transplantation due to Fuchs endothelial dystrophy and 5 due to other causes of bullous keratopathy. All patients received preoperative YAG iridotomy, intraoperatve additional surgical iridectomy using a 20 gauge cutter, nearly full intracameral air injection and immediate postoperative 250 mg acetazolamide and 18 mg dexamethasone, orally. The mean preoperative IOP was 8.3 mmHg and increased to 16.1 mmHg immediately after air injection, mean difference was 7.9 mmHg (p <0.001). The mean IOP at 1, 2, 3, 5, 12, 24 hours, 1 week and 1 month postoperative gradually decreased from 13.0, 12.6, 12.0, 11.9, 9.6, 9.6, 8.1 and 8.8 mmHg respectively (compared to preoperative IOP, p > 0.05). The highest IOP was 23 mmHg at 0, 1 and 2 hours postoperative. The mean Log MAR visual acuity increased from 0.6 preoperatively to 0.3 one month postoperatively (20/80 to 20/40).
Near complete intracameral air filling at the end of DMEK surgery only marginally increases IOP in the immediate and early postoperative period. Immediate (0 hour) postoperative time point is crucial for the highest pressure rising in normal DMEK patients after full intracameral air injection. The mean IOP is doubled up from preoperative value, then gradually decreased to baseline over 24 hours.
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