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Graft failure rate and complications after Descemet membrane endothelial keratoplasty in eyes with pre-existing glaucoma
PURPOSE: To evaluate the outcome of Descemet Membrane Endothelial Keratoplasty (DMEK) in eyes with pre-existing glaucoma. DESIGN: In this retrospective, observational case series we included data of 150 consecutive DMEKs in eyes with pre-existing glaucoma of 150 patients after excluding data of the...
Autores principales: | , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Springer Berlin Heidelberg
2022
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9836965/ https://www.ncbi.nlm.nih.gov/pubmed/36040539 http://dx.doi.org/10.1007/s00417-022-05813-4 |
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author | Maier, Anna-Karina B. Pilger, Daniel Gundlach, Enken Winterhalter, Sibylle Torun, Necip Dietrich-Ntoukas, Tina |
author_facet | Maier, Anna-Karina B. Pilger, Daniel Gundlach, Enken Winterhalter, Sibylle Torun, Necip Dietrich-Ntoukas, Tina |
author_sort | Maier, Anna-Karina B. |
collection | PubMed |
description | PURPOSE: To evaluate the outcome of Descemet Membrane Endothelial Keratoplasty (DMEK) in eyes with pre-existing glaucoma. DESIGN: In this retrospective, observational case series we included data of 150 consecutive DMEKs in eyes with pre-existing glaucoma of 150 patients after excluding data of the second treated eye of each patient and of re-DMEKs during follow-up. Cumulative incidences of IOP elevation (IOP > 21 mmHg or ≥ 10 mmHg increase in IOP from preoperative value), post-DMEK glaucoma (need of an additional intervention due to worsening of the IOP), graft rejection, and graft failure rate were analyzed using Kaplan–Meier survival analysis. COX regression analysis was used to evaluate independent risk factors. RESULTS: The 36-month cumulative incidence of IOP elevation was 53.5% [95 CI 43.5–63.5%] and of post-DMEK glaucoma 36.3% [95 CI 26.3–46.3%]. Graft rejection occurred with a 36-month cumulative incidence of 9.2% [CI 95% 2.3–16.1]. None of the analyzed risk factors increased the risk for the development of graft rejection. The 36-month cumulative incidence of graft failure was 16.6% [CI 95% 8.4–24.8]. Independent risk factors for graft failure were the indication for DMEK “status after graft failure” (n = 16) compared to Fuchs’ dystrophy (n = 74) (p = 0.045, HR 8.511 [CI 95% 1.054–68.756]) and pre-existing filtrating surgery via glaucoma drainage device (GDD) (n = 10) compared to no surgery/iridectomy (n = 109) (p = 0.014, HR 6.273 [CI 95% 1.456–27.031]). CONCLUSION: The risks of postoperative complications (IOP elevation, post-DMEK glaucoma, graft rejection, and graft failure) in patients with pre-existing glaucoma are high. In particular, pre-existing filtrating surgery via GDD implantation—but not trabeculectomy—and DMEK after graft failure increase the risk of graft failure. |
format | Online Article Text |
id | pubmed-9836965 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2022 |
publisher | Springer Berlin Heidelberg |
record_format | MEDLINE/PubMed |
spelling | pubmed-98369652023-01-14 Graft failure rate and complications after Descemet membrane endothelial keratoplasty in eyes with pre-existing glaucoma Maier, Anna-Karina B. Pilger, Daniel Gundlach, Enken Winterhalter, Sibylle Torun, Necip Dietrich-Ntoukas, Tina Graefes Arch Clin Exp Ophthalmol Cornea PURPOSE: To evaluate the outcome of Descemet Membrane Endothelial Keratoplasty (DMEK) in eyes with pre-existing glaucoma. DESIGN: In this retrospective, observational case series we included data of 150 consecutive DMEKs in eyes with pre-existing glaucoma of 150 patients after excluding data of the second treated eye of each patient and of re-DMEKs during follow-up. Cumulative incidences of IOP elevation (IOP > 21 mmHg or ≥ 10 mmHg increase in IOP from preoperative value), post-DMEK glaucoma (need of an additional intervention due to worsening of the IOP), graft rejection, and graft failure rate were analyzed using Kaplan–Meier survival analysis. COX regression analysis was used to evaluate independent risk factors. RESULTS: The 36-month cumulative incidence of IOP elevation was 53.5% [95 CI 43.5–63.5%] and of post-DMEK glaucoma 36.3% [95 CI 26.3–46.3%]. Graft rejection occurred with a 36-month cumulative incidence of 9.2% [CI 95% 2.3–16.1]. None of the analyzed risk factors increased the risk for the development of graft rejection. The 36-month cumulative incidence of graft failure was 16.6% [CI 95% 8.4–24.8]. Independent risk factors for graft failure were the indication for DMEK “status after graft failure” (n = 16) compared to Fuchs’ dystrophy (n = 74) (p = 0.045, HR 8.511 [CI 95% 1.054–68.756]) and pre-existing filtrating surgery via glaucoma drainage device (GDD) (n = 10) compared to no surgery/iridectomy (n = 109) (p = 0.014, HR 6.273 [CI 95% 1.456–27.031]). CONCLUSION: The risks of postoperative complications (IOP elevation, post-DMEK glaucoma, graft rejection, and graft failure) in patients with pre-existing glaucoma are high. In particular, pre-existing filtrating surgery via GDD implantation—but not trabeculectomy—and DMEK after graft failure increase the risk of graft failure. Springer Berlin Heidelberg 2022-08-30 2023 /pmc/articles/PMC9836965/ /pubmed/36040539 http://dx.doi.org/10.1007/s00417-022-05813-4 Text en © The Author(s) 2022 https://creativecommons.org/licenses/by/4.0/Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) . |
spellingShingle | Cornea Maier, Anna-Karina B. Pilger, Daniel Gundlach, Enken Winterhalter, Sibylle Torun, Necip Dietrich-Ntoukas, Tina Graft failure rate and complications after Descemet membrane endothelial keratoplasty in eyes with pre-existing glaucoma |
title | Graft failure rate and complications after Descemet membrane endothelial keratoplasty in eyes with pre-existing glaucoma |
title_full | Graft failure rate and complications after Descemet membrane endothelial keratoplasty in eyes with pre-existing glaucoma |
title_fullStr | Graft failure rate and complications after Descemet membrane endothelial keratoplasty in eyes with pre-existing glaucoma |
title_full_unstemmed | Graft failure rate and complications after Descemet membrane endothelial keratoplasty in eyes with pre-existing glaucoma |
title_short | Graft failure rate and complications after Descemet membrane endothelial keratoplasty in eyes with pre-existing glaucoma |
title_sort | graft failure rate and complications after descemet membrane endothelial keratoplasty in eyes with pre-existing glaucoma |
topic | Cornea |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9836965/ https://www.ncbi.nlm.nih.gov/pubmed/36040539 http://dx.doi.org/10.1007/s00417-022-05813-4 |
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