Long-Term Results Of Intraocular Pressure Elevation And Post-Dmek Glaucoma After Descemet Membrane Endothelial Keratoplasty: A Single Tertiary Centre Retrospective Analysis

Intraocular pressure (IOP) elevation occurs regularly after Descemet membrane endothelial keratoplasty (DMEK), largely from steroid-induced IOP elevation. This study evaluated the long-term incidence of IOP elevation and post-DMEK glaucoma after DMEK and DMEK combined with phacoemulsification (DMEK triple) in a single tertiary centre.

Sussex Eye Hospital, University Hospitals Sussex NHS Foundation Trust, Brighton, United Kingdom.

A total of 100 consecutive eyes that underwent DMEK or DMEK combined with phacoemulsification performed between 2017 and 2021 at Sussex Eye Hospital, United Kingdom were reviewed. Patients were followed up for a mean of 4 years (range 1.5-7 years). The 12-month and last visit incidence of IOP elevation and post-DMEK glaucoma were analysed using the Kaplan-Meier survival analysis. IOP elevation was defined as IOP ≥22 mm Hg. Post-DMEK glaucoma was defined as IOP elevation as above, including that of optic disc changes such as OCT RNFL thinning and/or glaucomatous visual field defects. In addition, data was collected on the type of steroid drop and any IOP-lowering medication taken by the patient at 12 months and last follow up.

The 12-month incidence of IOP elevation was 28%. In our study, most cases of IOP elevation within the first 12 months were secondary to a steroid response (98%), with the remainder due to transient pupillary block IOP elevation (2%). Of those patients who experienced steroid induced IOP elevation, 86.7% were taking a form of dexamethasone preparation eye drop, particularly in the first 12 months. In the majority of patients, IOP lowered after switching to lower potency steroid drops such as loteprednol or flourometholone . At last follow up, 14% required ongoing IOP-lowering drops. The incidence of post-DMEK glaucoma at the last follow up was 4% (range 1.5-7 years).

Incidence of IOP elevation is high in the first 12 months after DMEK, especially steroid-induced IOP elevation. Steroid-induced IOP elevation was almost always secondary to dexamethasone preparations. In the majority, steroid-induced IOP elevation could be treated effectively by tapering down the steroid medication or changing the steroid drop to a lower potency steroid.