Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2024 Oct 21;24(1):460.
doi: 10.1186/s12886-024-03728-8.

Impact of postoperative intraocular pressure elevation on graft endothelial cells in non-preexisting glaucoma eyes undergoing descemet membrane endothelial keratoplasty: a cohort study

Zi-Jun Xie  1   2 , Qing-Yang Wu  1   2 , Jing-Hao Qu  1   2 , Ji-Yu Lin  1   2 , Jing Hong  3   4
Affiliations

Impact of postoperative intraocular pressure elevation on graft endothelial cells in non-preexisting glaucoma eyes undergoing descemet membrane endothelial keratoplasty: a cohort study

Zi-Jun Xie et al. BMC Ophthalmol. .

Abstract

Background: Descemet membrane endothelial keratoplasty (DMEK) has become the dominant keratoplasty procedure. However, the impact of high intraocular pressure (IOP) on the DMEK prognosis in patients without preexisting glaucoma remains unknown.

Methods: Non-glaucoma patients who underwent DMEK in Peking University Third Hospital between July 2017 and March 2023 with a follow-up duration longer than six months were included in this cohort study. Eyes were divided into three groups: Group A) normal IOP; Group B) early IOP elevation (IOP ≥ 30 mmHg or increase of more than 10 mmHg from baseline within 3 days); Group C) intermediate-term IOP elevation (IOP > 21 mmHg or increase of more than 10 mmHg from baseline after 14 days postoperatively). The postoperative IOP, endothelial cell density (ECD), central corneal thickness (CCT), best-corrected visual acuity (BCVA) and rate of graft failure were analysed.

Results: Forty-seven eyes from forty-seven patients were included. Thirty-seven eyes were bullous keratopathy, and ten were Fuchs endothelial corneal dystrophy. Twenty-five eyes were classified as Group A, six as Group B and sixteen as Group C. The mean peak IOP was 49.00 ± 4.99 mmHg in Group B eyes and 31.89 ± 11.75 mmHg in Group C eyes. The postoperative BCVA significantly differed from that before surgery (P < 0.001). The ECD at 3 months after surgery in eyes with intermediate-term IOP elevation was lower (P = 0.032). Four eyes with intermediate-term IOP elevation developed graft failure (P = 0.001).

Conclusions: Intermediate-term IOP elevation after DMEK may reduce the graft ECD and lead to graft failure within six months after surgery. However, early IOP elevation had no effect on the prognosis. Careful IOP monitoring and intermediate-term IOP management should be conducted for graft protection.

Keywords: Corneal endothelial cell; Descemet membrane endothelial keratoplasty; Intraocular pressure elevation; Ocular hypertension.

PubMed Disclaimer

Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Survival curve of graft failure in eyes with or without intermediate-term IOP elevation
Fig. 2
Fig. 2
Slip lamp photography and AS-OCT examination results of an eye with graft failure and intermediate-term IOP elevation. The IOP elevation was identified at the 3-month follow-up time point after surgery. A, B and C represent the slit lamp photographs of the eye before, 1 week after and 3 months after DMEK surgery. D, E and F represent the AS-OCT examinations of the eye before, 1 week after and 3 months after DMEK surgery, respectively. The CCTs were 678, 613 and 949 μm, respectively
See this image and copyright information in PMC

References

    1. Mathews P, Benbow A, Corcoran K, et al. 2022 eye banking statistical report—executive summary. Eye Banking Corneal Transpl. 2023;2(3):e1-12.
    1. Malleron V, Bloch F, Zevering Y, et al. Evolution of corneal transplantation techniques and their indications in a French corneal transplant unit in 2000–2020. PLoS ONE. 2022;17(4):e0263686. 10.1371/journal.pone.0263686. - PMC - PubMed
    1. Flockerzi E, Turner C, Seitz B, et al. Descemet’s membrane endothelial keratoplasty is the predominant keratoplasty procedure in Germany since 2016: a report of the DOG-section cornea and its keratoplasty registry. Br J Ophthalmol. 2024;108(5):646–53. 10.1136/bjo-2022-323162. - PMC - PubMed
    1. Saini C, Davies EC, Chodosh J, et al. Glaucoma in patients with endothelial keratoplasty. Cornea. 2022;41(12):1584–99. 10.1097/ICO.0000000000003122. - PubMed
    1. Vu PQ, Aggarwal S, Lu Y, et al. Comparison of intraocular pressure, usage of topical steroids, need for intraocular pressure lowering drops, and incidence of glaucoma surgery up to 2 years after penetrating keratoplasty and endothelial keratoplasty. J Glaucoma. 2020. 10.1097/IJG.0000000000001635. [publishedOnlineFirst:2020/08/23]. - PubMed

MeSH terms

LinkOut - more resources