Descemet membrane endothelial keratoplasty and glaucoma.
AI Summary
DMEK patients face glaucoma risks from reverse pupillary block and steroid response. Early detection and management, including prophylactic iridectomy and careful steroid use, are crucial to preserve vision and graft survival.
Abstract
Purpose of review: The aim of this review is to describe the relationship between Descemet membrane endothelial keratoplasty (DMEK) and glaucoma.
Recent findings: Glaucoma after DMEK is a serious complication that may cause permanent visual loss, affect donor endothelial cells and graft survival. The mechanisms of raised intraocular pressure (IOP) after DMEK include reverse pupillary block in the early postoperative period, and steroid response in the late phase. The reduced risk of immunogenic graft rejection after DMEK necessitates a shorter duration of steroids, which may in turn reduce the risk of steroid response. On the other hand, eyes with preexisting glaucoma that undergo DMEK may have a poorer prognosis than those without glaucoma.
Summary
Early recognition and treatment of raised IOP is important after DMEK. Accurate IOP measurements after DMEK may be difficult to obtain because of the presence of an air bubble, corneal oedema, and corneal irregularities. A prophylactic peripheral iridectomy is recommended to prevent reverse pupillary block. Patients should posture face-up and be evaluated in the early postoperative period, as patients may be asymptomatic despite raised IOP. In order to reduce the risk of steroid response, weaker steroids may be prescribed after 1-3 months without adverse effects on DMEK outcomes.
MeSH Terms
Shields Classification
Key Concepts5
Glaucoma after Descemet membrane endothelial keratoplasty (DMEK) is a serious complication that may cause permanent visual loss, affect donor endothelial cells, and graft survival.
The mechanisms of raised intraocular pressure (IOP) after Descemet membrane endothelial keratoplasty (DMEK) include reverse pupillary block in the early postoperative period and steroid response in the late phase.
A prophylactic peripheral iridectomy is recommended to prevent reverse pupillary block after Descemet membrane endothelial keratoplasty (DMEK).
Patients who undergo Descemet membrane endothelial keratoplasty (DMEK) should posture face-up and be evaluated in the early postoperative period, as patients may be asymptomatic despite raised intraocular pressure (IOP).
Weaker steroids may be prescribed after 1-3 months following Descemet membrane endothelial keratoplasty (DMEK) to reduce the risk of steroid response without adverse effects on DMEK outcomes.
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