UCLA

Purpose

To evaluate outcomes of Descemet membrane endothelial keratoplasty (DMEK) in eyes with previous trabeculectomy or a drainage device.

Methods

This is a retrospective study of 108 consecutive DMEK performed between October 2013 and December 2015. All eyes were divided into 3 groups: surgical treatment (ST) group, medical treatment (MT) group, and control group. Visual improvement, endothelial cell loss, and postoperative complications, including rejection, graft failure, and intraocular pressure elevation (≥25 mm Hg) were evaluated.

Results

The length of follow-up was 9.7 ± 7.3 months. Best-corrected visual acuity (BCVA) improved postoperatively in 85.3% of the ST group, 100% of the MT group, and 93% of the control (P = 0.24). Significantly more lines of BCVA were gained in the ST and MT groups (8.1 ± 8.1 and 9.2 ± 6.3 lines, respectively) than in the control (4.8 ± 5.6 lines, P < 0.05). The mean time to BCVA was 2.9 ± 2.8 months for the ST group, 4.7 ± 5.3 months for the MT group, and 3.0 ± 3.3 months for the control (P = 0.75). Endothelial cell loss was greater in the ST group (44.6 ± 17.8%) than in the MT group (29.9 ± 12.0%) and the control group (32.7 ± 11.3%, P = 0.001). There was one primary failure and no secondary graft failures. The overall rejection rate was 0.9%. Postoperative intraocular pressure elevation was less common in the ST group (14.7%) and control (23.3%) than in the MT group (50.0%, P = 0.04). There was no difference in the air injection rate among all groups (P = 1.0).

Conclusions

DMEK in eyes with previous trabeculectomy and drainage device can result in very good short-term outcomes.