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Shawn Lin, Pitchaya Prapaipanich, Fei Yu, Anthony J Aldave, Sophie Xiaohui Deng; Outcomes of Descemet Membrane Endothelial Keratoplasty and Descemet Stripping Endothelial Keratoplasty in Patients With Previous Glaucoma Surgery. Invest. Ophthalmol. Vis. Sci. 2017;58(8):5681. doi: https://doi.org/.
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© ARVO (1962-2015); The Authors (2016-present)
To compare the outcomes of Descemet membrane endothelial keratoplasty (DMEK) and Descemet stripping endothelial keratoplasty (DSEK) in eyes with previous trabeculectomy and/or tube shunt implantation.
This is a retrospective chart review comparison of 148 DMEK and 596 DSEK procedures performed between August 2006 and November 2016. Forty-six of the DMEK procedures (31%) and 154 of the DSEK procedures (26%) were performed in eyes with previous trabeculectomy and/or tube shunt implantation. Outcome measures included best corrected visual acuity (BCVA), primary graft failure (PGF), secondary graft failure (SGF), endothelial cell (EC) loss and postoperative complications.
The mean duration of follow-up was 6.8 months in the DMEK group (range: 0.3—26.7 mo) and 24.1 months in the DSEK group (range: 0.2—96.6 mo) (p=0.0001). Patient age and sex were similar in the two groups (age: p=0.28, sex: p=0.13). There were no statistically significant differences between the preoperative BCVAs (p=0.10). Postoperatively, BCVA improved significantly in both the DMEK and DSEK groups, and there were no significant differences in final BCVA or in the proportion of patients with BCVA better than 20/30 (p=0.13, p=0.25).Secondary graft failure was significantly lower in the DMEK group (0%) than in the DSEK group (20.1%) (p=0.0003). Primary graft failure was lower in the DMEK group (0%) than in the DSEK group (5.2%), but did not reach statistical significance (p=0.20). Likewise, rejection rate was lower in the DMEK group (2.2%) than in the DSEK group (9.1%), but did not reach statistical significance (p=0.20). Air injection rate was significantly higher in the DMEK group than in the DSEK group (21.7% and 4.55%, p=0.0009). There were no differences in donor EC count (p=0.59) between the two groups. Endothelial cell loss was similar in the DMEK group (54%) and the DSEK group (47%) (p=0.35).
DMEK is an effective procedure to improve vision in eyes with previous trabeculectomy and tube shunt implantation. PGF, EC loss and overall improvement in visual acuity were similar to that of DSEK. The DMEK group had a lower incidence of SGF and a higher rate of air injection. However, length of follow up was significantly longer in the DSEK group. A larger study with longer follow up in the DMEK group is necessary to confirm the above finding.
This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.
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