Descemet membrane endothelial keratoplasty and glaucoma

Descemet membrane endothelial keratoplasty and glaucoma Purpose of reviewThe aim of this review is to describe the relationship between Descemet membrane endothelial keratoplasty (DMEK) and glaucoma.Recent findingsGlaucoma 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.SummaryEarly 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. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Current Opinion in Ophthalmology Wolters Kluwer Health

Descemet membrane endothelial keratoplasty and glaucoma

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Publisher
Wolters Kluwer Health
Copyright
Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.
ISSN
1040-8738
eISSN
1531-7021
D.O.I.
10.1097/ICU.0000000000000454
Publisher site
See Article on Publisher Site

Abstract

Purpose of reviewThe aim of this review is to describe the relationship between Descemet membrane endothelial keratoplasty (DMEK) and glaucoma.Recent findingsGlaucoma 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.SummaryEarly 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.

Journal

Current Opinion in OphthalmologyWolters Kluwer Health

Published: Mar 1, 2018

References

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