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. 2019 Oct;257(10):2203-2211.
doi: 10.1007/s00417-019-04437-5. Epub 2019 Aug 10.

Postoperative pain following Descemet membrane endothelial keratoplasty (DMEK): a prospective study

Johannes Loeser  1   2 , Julian Schwemmer  1   3 , Antoniu-Oreste Gostian  4   5 , Magdalena Gostian  1 , Björn Bachmann  3 , Claus Cursiefen  3 , Ludwig M Heindl  6
Affiliations

Postoperative pain following Descemet membrane endothelial keratoplasty (DMEK): a prospective study

Johannes Loeser et al. Graefes Arch Clin Exp Ophthalmol. 2019 Oct.

Abstract

Purpose: To evaluate postoperative pain following Descemet membrane endothelial keratoplasty (DMEK).

Methods: Seventy-one patients completed perioperatively (day before surgery, day of surgery, 1st, 2nd, and 3rd day after surgery) four different questionnaires (a hospital internal protocol, QUIPS, PainDETECT®, and SF36) regarding their pain and other clinical parameters such as constipation, tiredness, vertigo, sleep disorders, concentration disorders, nausea, and emesis. All standardised questionnaires were evaluated to quantify average pain intensity as well as maximum pain intensity (NRS, 0 [no pain] to 10 [maximal pain], respectively). Analgesic treatment and intraocular pressure (IOP) during the perioperative stay were documented.

Results: Mean average pain intensity was 0.70 ± 1.64 before surgery, 1.97 ± 2.05 on the day of surgery, 1.39 ± 1.68 on day 1, 0.87 ± 1.36 on day 2, and 0.81 ± 1.24 on day 3 after surgery. Maximum pain intensity was 0.65 ± 1.81 before surgery, 3.35 ± 2.98 on the day of surgery, 2.68 ± 2.99 on day 1, 1.49 ± 2.15 on day 2, and 1.26 ± 2.02 on day 3 after surgery. During the first three postoperative days, over 90% of the patients stated no or well tolerable pain. Eighty-three percent had postoperatively no need for analgesics at all. On the first two postoperative days, maximum IOP correlated significantly with reported increased maximum pain intensity (p = 0.043 and p = 0.029, respectively). All patients had very little problems with constipation, tiredness, vertigo, sleep disorder, concentration disorders, nausea, and emesis.

Conclusions: DMEK is associated with low postoperative pain intensity. Strong pain increase may indicate IOP elevation and should be further investigated and treated.

Clinical trial registration: German Clinical Trial Register (DRKS00013995).

Keywords: Cornea; Descemet membrane endothelial keratoplasty (DMEK); Keratoplasty; Pain; Quality management; Transplantation.

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