title: Immediate Postoperative Intraocular Pressure Changes After Anterior Chamber Air Fill in Descemet Membrane Endothelial Keratoplasty.
abstract: OBJECTIVE
  To monitor the intraocular pressure (IOP) changes immediately after anterior chamber air tamponade in Descemet membrane endothelial keratoplasty (DMEK).
  
  
  METHODS
  Twenty-four patients undergoing DMEK and 16 patients undergoing rebubbling after DMEK were enrolled (n = 40). All DMEK patients had inferior iridectomy and nearly full intracameral air tamponade with an aimed IOP of 25 mm Hg at the end of surgery. The IOP was measured at 1, 2, 3, 5, 12, 24 hours and 1 week postoperatively.
  
  
  RESULTS
  After anterior chamber air fill in DMEK, the IOP increased from preoperative baseline, 12.1 ± 2.9 mm Hg, to 26.3 ± 4.7 mm Hg, P < 0.001. Mean IOP was significantly elevated in the first 2 hours, 19.4 ± 10.5 mm Hg and 17.0 ± 7.4 mm Hg, P = 0.007 and 0.006, respectively. Then, it lowered to the baseline level, 14.0 ± 4.7 mm Hg, P > 0.05, and remained stable during follow-ups. An asymptomatic IOP elevation above 30 mm Hg was detected in 3 patients (12.5%) within the first 2 hours. None had preexisting glaucoma. Most episodes could be controlled by antiglaucoma medications and upright positioning. The pattern of IOP changes after rebubbling was similar to that after DMEK but the IOP dropped sharply to the baseline level after 1 hour and had no incidence of IOP elevations beyond 30 mm Hg.
  
  
  CONCLUSIONS
  Adequate inferior iridectomy greatly alleviates the risk and severity of acute IOP rises after nearly full anterior chamber air tamponade in DMEK. Standard IOP adjustment at the end of DMEK surgery with postoperative IOP monitoring especially in the first 2 postoperative hours is advisable when there is no postoperative default air release.
authors.affiliation: *Department of Ophthalmology, University of Cologne, Cologne, Germany; †Department of Ophthalmology, Phramongkutklao Hospital, Bangkok, Thailand; and ‡Institute for Medical Statistics, Informatics and Epidemiology, University of Cologne, Germany.
authors.forename: Tisha P
authors.initials: TP
authors.lastname: Stanzel
authors.forename: Lebriz
authors.initials: L
authors.lastname: Ersoy
authors.forename: Wiwan
authors.initials: W
authors.lastname: Sansanayudh
authors.forename: Moritz
authors.initials: M
authors.lastname: Felsch
authors.forename: Thomas
authors.initials: T
authors.lastname: Dietlein
authors.forename: Bjoern
authors.initials: B
authors.lastname: Bachmann
authors.forename: Claus
authors.initials: C
authors.lastname: Cursiefen
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000867:Anterior Chamber / Q000503:physiopathology* / Q000601:surgery; D003886:Descemet Membrane / Q000601:surgery*; D057111:Descemet Stripping Endothelial Keratoplasty / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D005901:Glaucoma / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D007429:Intraocular Pressure / Q000502:physiology*; D008297:Male; D008875:Middle Aged; D011184:Postoperative Period; D013997:Time Factors; D014065:Tonometry, Ocular; D014792:Visual Acuity