Nd:YAG Laser Iridotomy Versus Surgical Iridectomy in Descemet Membrane Endothelial Keratoplasty: Comparison of Postoperative Outcome and Incidence of Ocular Hypertension.

Purpose: To evaluate outcome and incidence of ocular hypertension after Descemet membrane endothelial keratoplasty (DMEK) and DMEK combined with cataract surgery (triple DMEK) after Nd:YAG laser iridotomy (IO) and surgical iridectomy (IE).

Methods: This is a single-center, retrospective cohort study of patients who underwent DMEK or triple DMEK surgery at the Department of Ophthalmology, University Hospital Düsseldorf, Germany, from January 2018 to June 2020 and had received either a prophylactic preoperative IO or an intraoperative IE. Patient demographic data; best corrected visual acuity; central corneal thickness; intraocular pressure (IOP); endothelial cell density; and complications such as occurrence of early postoperative IOP elevation, macular edema, rebubbling rate, and incidence of glaucoma were analyzed.

Results: A total of 75 patients were included in each study arm with a follow-up of 22.04 ± 12.8 months. Best corrected visual acuity significantly increased postoperatively in both cohorts without significant differences. Early postoperative IOP elevation due to pupillary block was significantly more common in eyes with IO (33.3%, n = 25) than with IE (2.67%, n = 2, P < 0.001). The incidence of de novo glaucoma was 5.34% in both cohorts without significant differences in prevalence at the last follow-up (YAG IO cohort: 17.3%, IE cohort: 14.7%, P > 0.05). Rebubbling was required in 16% (n = 12) of eyes in each cohort (P > 0.999).

Conclusions: Postoperative pupillary block after DMEK occurs significantly more often after preoperative Nd:YAG laser iridotomy compared with surgical intraoperative iridectomy but does not negatively affect long-term visual outcome or glaucoma incidence after DMEK.