[Therapeutic Options in Endothelial Decompensation Following Glaucoma Surgery]

During the last few years, Descemet membrane endothelial keratoplasty (DMEK) has become first line surgical treatment for patients with Fuchs endothelial dystrophy or pseudophakic bullous keratopathy. However, in eyes with previous trabeculectomy or implantation of a glaucoma drainage device, this surgical technique, where the diseased Descemet's membrane and endothelium are replaced by a lamella of donor Descemet's membrane and endothelium, may have some limitations. These include complications during surgery such as difficult unfolding of the graft in the presence of a glaucoma tube with a risk of an increased endothelial cell loss and problems after surgery like the loss of the air/gas tamponade in the anterior chamber through the opening of the trabeculectomy or the tube, with an increased risk of graft dislocation. The following review contains information on endothelial cell loss following different glaucoma operations, discusses the advantages and disadvantages of various keratoplasty techniques and gives some technical advice for improving the surgical technique.