Predictive Factors for Long-Term De Novo Intraocular Pressure Elevation After Descemet Membrane Endothelial Keratoplasty.

Abstract

Purpose: This study aimed to examine the prevalence, associated risk factors, and management of late-onset intraocular pressure (IOP) elevation after Descemet membrane endothelial keratoplasty (DMEK).

Methods: Data of 415 patients who underwent DMEK between January 2018 and August 2024 were retrospectively analyzed and 54 eyes of 54 patients who developed de novo IOP elevation during the follow-up period were included. IOP elevation was defined as IOP >22 mm Hg or an increase of >10 mm Hg compared with the preoperative baseline values. Patients with preexisting glaucoma were excluded. The patients' demographic data, ocular risk factors, indications for DMEK, tamponade type, rebubbling rates, use of antiglaucomatous medication, peak and regulated IOP, necessity for glaucoma surgery, best-corrected visual acuity, and mean follow-up time were evaluated.

Results: Among the 415 patients who underwent DMEK, 54 (13%) experienced IOP elevation. After switching from dexamethasone to loteprednol etabonate 0.5%, 23 patients (42.5%) had IOP control without antiglaucomatous treatment. Patients with peripheral anterior synechiae exhibited an increased risk of using antiglaucomatous medication and undergoing antiglaucomatous surgery (P = 0.03, OR 3.84, confidence interval, 1.13-12.95; P = 0.03, OR, 6.2, 95% confidence interval, 1.11-34.44, respectively). Peak IOP was higher in eyes with pseudoexfoliation in the postoperative period after DMEK (P = 0.03).

Conclusions: Pseudoexfoliation, prolonged steroid use, and peripheral anterior synechiae were identified as risk factors for IOP elevation after DMEK. In these complex cases, switching to a milder steroid at an earlier stage may be recommended, provided that the balance is maintained to avoid compromising graft survival.