A Review of Outcomes of Descemet Membrane Endothelial Keratoplasty and Descemet Stripping Automated Endothelial Keratoplasty Interventions in Patients with Pre-Existing Glaucoma

Abstract

Glaucoma is known to impair the function of corneal endothelial cells for various reasons, which increases the likelihood of patients with glaucoma requiring endothelial keratoplasty. Among the techniques available, Descemet membrane endothelial keratoplasty (DMEK) and Descemet stripping automated endothelial keratoplasty (DSAEK) each present unique challenges, particularly for those with a history of glaucoma surgery. We conducted a literature review to evaluate the outcomes of DMEK and DSAEK in glaucoma patients, focusing on factors such as visual prognosis, graft survival, glaucoma exacerbations, and any necessary surgical modifications. The findings indicate that DMEK tends to provide better visual outcomes compared to DSAEK, with a lower rate of steroid responders due to a shorter postoperative steroid regimen. While DMEK has shown a higher incidence of graft detachment and a lower rate of graft rejection, compared to DSAEK, in the general population, the specific data regarding these outcomes in glaucoma patients remain scarce in the existing literature. Overall, the survival rates of both grafting techniques do not show significant differences within the glaucoma patient population. To draw more definitive conclusions about graft survival between the two methods, a greater number of comparative studies with longer follow-up periods is needed.

Keywords: DMEK; DSAEK; endothelial keratoplasty; glaucoma; graft survival.