Risk Factors and Effect of Sub-Tenon Triamcinolone on Cystoid Macular Edema After Descemet Membrane Endothelial Keratoplasty: Association and Risk Factor Analysis.

PURPOSE: To evaluate whether sub-Tenon triamcinolone acetonide (STTA) reduces cystoid macular edema (CME) after Descemet membrane endothelial keratoplasty (DMEK) and to identify associated risk factors.

METHODS

This retrospective, multicenter observational study included 96 eyes of 78 patients who underwent DMEK in Japan and were followed for ≥12 months. Demographic, ocular, and surgical variables were collected. CME was assessed using spectral-domain optical coherence tomography. Kaplan-Meier analysis with log-rank testing compared CME-free survival between eyes with and without STTA. Cox proportional hazards regression identified risk factors. Best-corrected visual acuity at 12 months was compared between CME-positive and CME-negative eyes.

RESULTS

CME developed in 13 eyes (13.5%). Kaplan-Meier analysis showed no significant difference in CME-free survival between STTA users (90.9%) and nonusers (84.6%) at 360 days (P = 0.593). Most CME cases occurred within 90 days postoperatively. Multivariable analysis indicated that preoperative anterior chamber depth showed a trend toward association with CME (P = 0.058), and rebubbling was independently associated with increased risk (P = 0.034). Eyes requiring ≥2 rebubbling procedures had a higher CME risk compared with eyes without rebubbling (P = 0.029). Age, STTA use, and nonsteroidal antiinflammatory drug use were not significantly associated with CME. At 12 months, best-corrected visual acuity did not differ between groups (P = 0.419).

CONCLUSIONS

STTA was not significantly associated with a lower incidence of CME after DMEK. Shallow anterior chamber depth showed a trend toward association, and rebubbling was significantly associated, suggesting the need for careful postoperative evaluation.