Descemet membrane endothelial keratoplasty and penetrating keratoplasty in pseudophakic bullous keratopathy: comparison of visual outcomes, graft survival rates, and complications

Abstract

Objective: To compare the outcomes of Descemet Membrane Endothelial Keratoplasty (DMEK) and Penetrating Keratoplasty (PK) in patients with pseudophakic bullous keratopathy (PBK).

Methods: Records of 51 eyes of 51 PBK patients (32 male, 19 female) who underwent PK (Group1=38 eyes) and DMEK (Group 2=13 eyes) were reviewed retrospectively. The two groups were compared for Best-corrected visual acuity (BCVA), graft survival rates, and complications.

Results: The mean age was 69.1 and 67.1 years in group 1 and group 2, respectively. First-year cumulative survival rates for group 1 and group 2 were 92.1% and 61.5%, respectively, and 89.1% and 51.3% in the second year (P=0.001 by log-rank test). At the last follow-up visit, 2.7% of Group 1 and 30.8% of Group 2 had a BCVA of 0.3 or better (P=0.004). Graft failure was observed in 12 eyes (31.6%) in group 1 and 8 eyes (61.5%) in group 2 (P=0.056). At the last examination, the rates of transparent grafts were 73.7% and 69.2% in group 1 and group 2, respectively (P=0.756). Postoperative glaucoma was observed in 4 eyes (30.8%) in the group 2 and 4 eyes (10.5%) in the group 1 (P=0.083). There was no significant difference between the two groups regarding other complications (P>0.05).

Conclusions: DMEK surgery offers a better visual outcome than PK for the treatment of PBK. Careful follow-up of patients is required in terms of glaucoma and graft failure after DMEK. Although the graft survival rate was lower in the DMEK group, a similar rate of graft transparency was achieved at the final examination with repeated DMEK surgery.

Keywords

• Deep anterior lamellar keratoplasty
• descemet membrane endothelial keratoplasty
• penetrating keratoplasty
• macular corneal dystrophy

Ethical Statement

The study protocol was approved by the University of Health Sciences Ankara Training and Research Hospital Ethics Committee (Date: 21.02.2024, Number: E-93471371-514.10-237451230)

References

1. 1. Peh GSL, Ang HP, Lwin CN, et al. Regulatory Compliant Tissue-Engineered Human Corneal Endothelial Grafts Restore Corneal Function of Rabbits with Bullous Keratopathy. Sci Rep. 2017;7(1):14149. doi: 10.1038/s41598-017-14723-z.
2. 2. Briceno-Lopez C, Burguera-Giménez N, García-Domene MC, Díez-Ajenjo MA, Peris-Martínez C, Luque MJ. Corneal Edema after Cataract Surgery. J Clin Med. 2023;12(21):6751. doi: 10.3390/jcm12216751.
3. 3. Lee WB, Jacobs DS, Musch DC, Kaufman SC, Reinhart WJ, Shtein RM. Descemet's stripping endothelial keratoplasty: safety and outcomes: a report by the American Academy of Ophthalmology. Ophthalmology. 2009;116(9):1818-1830. doi: 10.1016/j.ophtha.2009.06.021.
4. 4. Anshu A, Price MO, Tan DT, Price FW Jr. Endothelial keratoplasty: a revolution in evolution. Surv Ophthalmol. 2012;57(3):236-252. doi: 10.1016/j.survophthal.2011.10.005.
5. 5. Naveiras M, Dirisamer M, Parker J, et al. Causes of glaucoma after descemet membrane endothelial keratoplasty. Am J Ophthalmol. 2012;153(5):958-966.e1. doi: 10.1016/j.ajo.2011.10.003.
6. 6. Agarwal A, Narang P, Kumar DA, Agarwal A. Young donor-graft assisted endothelial keratoplasty (PDEK/DMEK) with epithelial debridement for chronic pseudophakic bullous keratopathy. Can J Ophthalmol. 2017;52(5):519-526. doi: 10.1016/j.jcjo.2017.03.004.
7. 7. Jung YH, Choi HJ, Kim MK, Oh JY. Etiology and outcome of penetrating keratoplasty in bullous keratopathy post-cataract surgery vs post-glaucoma surgery. PLoS One. 2023;18(5):e0285419. doi: 10.1371/journal.pone.0285419.
8. 8. Liarakos VS, Ham L, Dapena I, et al. Endothelial keratoplasty for bullous keratopathy in eyes with an anterior chamber intraocular lens. J Cataract Refract Surg. 2013;39(12):1835-1845. doi: 10.1016/j.jcrs.2013.05.045.

9. 9. Wai YZ, Pee XK, Lai YP, Alias R. Descemet stripping endothelial keratoplasty versus penetrating keratoplasty in bullous keratopathy: A 2-year analysis of graft survival and outcomes in a tertiary eye centre in Kuala Lumpur. Med J Malaysia. 2023;78(1):74-78.
10. 10. Chen Y, Sun S, Gao M, Liu Q, Wang Z. Comparative observation of the efficacy of simplified Descemet stripping endothelial keratoplasty and penetrating keratoplasty in treating bullous keratopathy. Exp Ther Med. 2020;20(5):31. doi: 10.3892/etm.2020.9158.
11. 11. Kim SE, Lim SA, Byun YS, Joo CK. Comparison of Long-term Clinical Outcomes between Descemet's Stripping Automated Endothelial Keratoplasty and Penetrating Keratoplasty in Patients with Bullous Keratopathy. Korean J Ophthalmol. 2016;30(6):443-450. doi: 10.3341/kjo.2016.30.6.443.
12. 12. Vu PQ, Aggarwal S, Lu Y, Xie K, Wade M, Bhatt A. Comparison of Intraocular Pressure, Usage of Topical Steroids, Need for Intraocular Pressure Lowering Drops, and Incidence of Glaucoma Surgery Up to 2 Years After Penetrating Keratoplasty and Endothelial Keratoplasty. J Glaucoma. 2020;29(12):1120-1125. doi: 10.1097/IJG.0000000000001635.
13. 13. Huber KK, Maier AK, Klamann MK, et al. Glaucoma in penetrating keratoplasty: risk factors, management and outcome. Graefes Arch Clin Exp Ophthalmol. 2013;251(1):105-116. doi: 10.1007/s00417-012-2065-x.
14. 14. Maier AK, Wolf T, Gundlach E, et al. Intraocular pressure elevation and post-DMEK glaucoma following Descemet membrane endothelial keratoplasty. Graefes Arch Clin Exp Ophthalmol. 2014;252(12):1947-1954. doi: 10.1007/s00417-014-2757-5.
15. 15. Sharma RA, Bursztyn LL, Golesic E, Mather R, Tingey DP. Comparison of intraocular pressure post penetrating keratoplasty vs Descemet's stripping endothelial keratoplasty. Can J Ophthalmol. 2016;51(1):19-24. doi: 10.1016/j.jcjo.2015.09.014.
16. 16. Aldarrab A, Alsakran W, Al-Swailem SA, Al-Shahwan SA. Comparison of Glaucoma Therapy Escalation After Penetrating Keratoplasty to Descemet Stripping Automated Endothelial Keratoplasty for the Treatment of Pseudophakic Bullous Keratopathy: A Cohort Study. Middle East Afr J Ophthalmol. 2023;29(2):72-79. doi: 10.4103/meajo.meajo_21_22.