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To compare post-operative intraocular pressure (IOP), steroid use, and glaucoma incidence between full thickness Penetrating Keratoplasty (PKP) with newer partial-thickness techniques of Descemet’s Membrane Endothelial Keratoplasty (DMEK) and Descemet’s Stripping Automated Endothelial Keratoplasty (DSAEK or DSEK).
This is a retrospective review of keratoplasties performed from July 2012 to July 2017 at the University of California, Irvine Gavin Herbert Eye Institute. Patients with a prior history of glaucoma, previous corneal or glaucoma surgery, concurrent major surgery, active infections, or those undergoing emergent surgery were excluded. In total, 239 eyes (212 patients) that underwent PKP (N=127), DMEK (N=46), or DSAEK (N=66) were included. IOP, daily steroid frequency, number of glaucoma medications, and recommendations for glaucoma surgery were recorded preoperatively and at several postoperative visits: postoperative day 1 (POD1), week 1 (POW1), and months up to 24 months (POM1-24).
There was no significant difference in preoperative IOP among the 3 groups. IOP for PKP was higher than DMEK and DSEK at POW1, POM1, 6, and 24 (p<0.05). IOP for PKP was higher than DMEK but not DSEK at POM12 (p=0.028). There was no significant difference in IOP between DMEK and DSEK at all time points. PKP required a higher frequency of steroids than DSAEK and DMEK at POM3, 6, 12, and 24 (p<0.05). More glaucoma medications were required for DSAEK than DMEK and PKP at POD1 and POW1 (p<0.05). More glaucoma medications were used for DSAEK than DMEK but not PKP at POM3 and 12 (p<0.05). About 6-7% of patients needed glaucoma surgery by POM24, without significant differences among the groups.
When compared to full-thickness transplants, eyes undergoing endothelial keratoplasties benefited from lower postoperative IOP and a lower frequency of topical steroids, but did not reduce the need for glaucoma drops or surgery over a 2-year postoperative period. This may be used to guide surgical decisions and postoperative management.