Japanese journal of ophthalmology · 2026
Descemet membrane endothelial keratoplasty versus descemet's stripping automated endothelial keratoplasty following glaucoma filtering surgery: clinical outcomes and immunologic considerations.
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Kasamatsu Hirotsugu, Koh Shizuka, Yagi-Yaguchi Yukari, Tomida Daisuke, Yamaguchi Takefumi
Аннотация
PURPOSE: To investigate the clinical outcomes and immunologic implications following Descemet membrane endothelial keratoplasty (DMEK) and Descemet's stripping automated endothelial keratoplasty (DSAEK) in eyes with prior glaucoma filtering surgery (GFS).
STUDY DESIGN: Retrospective comparative case series.
METHODS: This study included 29 eyes with prior GFS that underwent DMEK (n=7) or DSAEK (n=22). Outcomes include host central corneal thickness (CCT), short-term complications (graft detachment, rebubbling, and primary graft failure [PGF]), corrected distance visual acuity (CDVA), immunologic graft rejection, endothelial cell loss (ECL), and graft survival.
RESULTS: DMEK showed significantly faster recovery of host CCT compared to DSAEK on postoperative day 1 (573.2 ± 93.3 μm vs. 773.0 ± 40.7 μm; p = 0.02) and day 3 (591.1 ± 93.2 μm vs. 721.5 ± 108.9 μm; p = 0.003). Graft detachment rates were similar between the groups; rebubbling and PGF occurred only after DSAEK (14% and 9%). CDVA at 1 month (0.5 ± 0.5 vs. 1.0 ± 0.5) and at 3 months (0.4 ± 0.4 vs. 0.8 ± 0.4) was significantly better in the DMEK group (both p = 0.04). The 2-year cumulative rejection rates (14% in both groups), 2-year ECL (70 ± 17% vs. 71 ± 15%), and 2-year graft survival rate (100% vs. 81 ± 10%) were comparable.
CONCLUSIONS: DMEK appears to be a viable option after GFS, given its favorable clinical profile. However, the relatively high incidence of immunologic events in both groups suggests that alterations in the ocular immune environment following GFS may influence postoperative outcomes.
STUDY DESIGN: Retrospective comparative case series.
METHODS: This study included 29 eyes with prior GFS that underwent DMEK (n=7) or DSAEK (n=22). Outcomes include host central corneal thickness (CCT), short-term complications (graft detachment, rebubbling, and primary graft failure [PGF]), corrected distance visual acuity (CDVA), immunologic graft rejection, endothelial cell loss (ECL), and graft survival.
RESULTS: DMEK showed significantly faster recovery of host CCT compared to DSAEK on postoperative day 1 (573.2 ± 93.3 μm vs. 773.0 ± 40.7 μm; p = 0.02) and day 3 (591.1 ± 93.2 μm vs. 721.5 ± 108.9 μm; p = 0.003). Graft detachment rates were similar between the groups; rebubbling and PGF occurred only after DSAEK (14% and 9%). CDVA at 1 month (0.5 ± 0.5 vs. 1.0 ± 0.5) and at 3 months (0.4 ± 0.4 vs. 0.8 ± 0.4) was significantly better in the DMEK group (both p = 0.04). The 2-year cumulative rejection rates (14% in both groups), 2-year ECL (70 ± 17% vs. 71 ± 15%), and 2-year graft survival rate (100% vs. 81 ± 10%) were comparable.
CONCLUSIONS: DMEK appears to be a viable option after GFS, given its favorable clinical profile. However, the relatively high incidence of immunologic events in both groups suggests that alterations in the ocular immune environment following GFS may influence postoperative outcomes.