Purpose

To evaluate 4-year outcomes of Descemet membrane endothelial keratoplasty (DMEK) in eyes with previous glaucoma surgery.

Design

Retrospective, comparative case series.

Methods

Patients with previous trabeculectomy or glaucoma drainage device (GDD) implantation who later underwent DMEK (study group) were matched for follow-up duration with Fuchs dystrophy DMEK patients (control group). The minimum follow-up was 18 months. Primary outcomes included graft survival and rejection rates, and secondary outcomes included rates of detachment/rebubble, endothelial cell loss, best spectacle-corrected visual acuity, intraocular pressure, and glaucoma medications/surgeries. Subgroup analysis compared eyes with and without a GDD.

Results

Ninety-four eyes of 91 patients were included. There were 51 eyes of 49 patients in the study group (GDD = 32 eyes, no GDD = 19 eyes) and 43 eyes of 42 patients in the control group. The mean follow-up was 37.9 ± 15.2 and 33.8 ± 13.5 months, respectively (P = .322). Graft survival probability of the study group at 12, 24, 36, and 48 months was 75%, 60%, 43%, and 27%, respectively, compared with a consistent 88% in the control group (P < .001). Survival curves of study subgroups (GDD and no GDD) were significantly lower than the control group (P < .001). Rejection rates in the study and control groups were 19.6% and 2.3%, respectively (P = .010). Endothelial cell loss in the study group was 12%-22% higher than the control group at 12, 24, 36, and 48 months (P = .049, P = .027, P = .200, and P = .004).

Conclusions

In eyes with previous glaucoma surgery, DMEK has good early outcomes, but longer-term rejection and failure rates are high. Physicians and patients should be cognizant of the high likelihood of graft failure in this setting.

中文翻译：

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在曾有青光眼手术的患者中进行Descemet膜内皮角膜移植手术的四年生存率。

目的

评估先前有青光眼手术的眼睛进行Desmet膜内皮角膜移植术（DMEK）的4年结果。

设计

回顾性比较案例系列。

方法

先前接受小梁切除术或青光眼引流器（GDD）植入且后来接受DMEK的患者（研究组）与Fuchs营养不良DMEK患者（对照组）进行随访。最小随访时间为18个月。主要结局包括移植物存活率和排斥率，次要结局包括脱离/重新起泡率，内皮细胞损失，最佳眼镜矫正视力，眼压和青光眼药物/手术率。亚组分析比较了有和没有GDD的眼睛。

结果

纳入91例患者的94只眼。研究组49例患者中有51眼（GDD = 32眼，无GDD = 19眼），对照组42例中有43眼。平均随访时间分别为37.9±15.2和33.8±13.5个月（P  = 0.322）。研究组在第12、24、36和48个月的移植存活率分别为75％，60％，43％和27％，而对照组为88％（P <.001）。研究亚组（GDD和无GDD）的生存曲线显着低于对照组（P <.001）。研究组和对照组的排斥率分别为19.6％和2.3％（P = .010）。在 12、24、36和48个月时，研究组的内皮细胞损失比对照组高12％-22％（P = .049，P  = .027，P  = .200和P  = .004） 。

结论

在接受过青光眼手术的眼中，DMEK早期效果良好，但长期排斥反应和失败率很高。医生和患者应意识到这种情况下移植失败的可能性很高。