title: Causes of glaucoma after descemet membrane endothelial keratoplasty.
abstract: OBJECTIVE
  To describe the incidence and causes of glaucoma after Descemet membrane endothelial keratoplasty (DMEK).
  
  
  METHODS
  Nonrandomized prospective cohort study at a tertiary referral center.
  
  
  METHODS
  The incidence of glaucoma was evaluated in the first 275 consecutive eyes that underwent DMEK for Fuchs endothelial dystrophy (260 eyes) or bullous keratopathy (15 eyes). Glaucoma was defined as a postoperative intraocular pressure (IOP) elevation of ≥24 mm Hg, or ≥10 mm Hg from the preoperative baseline. If possible, the cause of glaucoma was identified, and best-corrected visual acuity (BCVA), endothelial cell density (ECD), and postoperative course were documented, with a mean follow-up of 22 (± 13) months.
  
  
  RESULTS
  Overall, 18 eyes (6.5%) showed postoperative glaucoma after DMEK. Seven eyes (2.5%) had an exacerbation of a pre-existing glaucoma. Eleven eyes (4%) presented with a de novo IOP elevation, associated with air bubble-induced mechanical angle closure (2%), steroid response (0.7%), or peripheral anterior synechiae (0.4%), or without detectable cause (0.7%). Two eyes (0.7%) required glaucoma surgery after DMEK. At 6 months, all eyes had a BCVA of ≥20/40 (≥0.5), and 81% reached ≥20/25 (≥0.8) (n = 16); mean ECD was 1660 (± 554) cells/mm(2) (n = 15) (P > .1).
  
  
  CONCLUSIONS
  Glaucoma after DMEK may be a relatively frequent complication that could be avoided by reducing the residual postoperative air bubble to 30% in phakic eyes, applying a population-specific steroid regime, and avoiding decentration of the Descemet graft. Eyes with a history of glaucoma may need close IOP monitoring in the first postoperative months, especially in eyes with an angle-supported phakic intraocular lens.
authors.affiliation: Netherlands Institute for Innovative Ocular Surgery, Rotterdam, The Netherlands.
authors.forename: Miguel
authors.initials: M
authors.lastname: Naveiras
authors.forename: Martin
authors.initials: M
authors.lastname: Dirisamer
authors.forename: Jack
authors.initials: J
authors.lastname: Parker
authors.forename: Lisanne
authors.initials: L
authors.lastname: Ham
authors.forename: Korine
authors.initials: K
authors.lastname: van Dijk
authors.forename: Isabel
authors.initials: I
authors.lastname: Dapena
authors.forename: Gerrit R J
authors.initials: GR
authors.lastname: Melles
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002452:Cell Count; D057111:Descemet Stripping Endothelial Keratoplasty; D003907:Dexamethasone / Q000008:administration & dosage; D004728:Endothelium, Corneal; D005260:Female; D005469:Fluorometholone / Q000008:administration & dosage; D005500:Follow-Up Studies; D005642:Fuchs' Endothelial Dystrophy / Q000601:surgery; D005901:Glaucoma / Q000188:drug therapy / Q000209:etiology* / Q000503:physiopathology; D005938:Glucocorticoids / Q000008:administration & dosage; D006801:Humans; D015994:Incidence; D007429:Intraocular Pressure / Q000502:physiology; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D011446:Prospective Studies; D012307:Risk Factors; D014792:Visual Acuity / Q000502:physiology
chemical_list: D005938:Glucocorticoids; D003907:Dexamethasone; D005469:Fluorometholone