Avoiding Post-DMEK IOP Elevation: Insights from a Standardized Surgical Approach.

Area of Science:

• Ophthalmology
• Corneal Surgery
• Glaucoma Management

Background:

• Descemet membrane endothelial keratoplasty (DMEK) is a prevalent corneal transplant procedure.
• Elevated intraocular pressure (IOP) is a common early complication following DMEK.
• Understanding early postoperative IOP trends is crucial for managing potential complications.

Purpose of the Study:

• To characterize early postoperative IOP behavior after DMEK using 10% sulfur hexafluoride (SF6) gas tamponade.
• To determine the frequency and timing of IOP-lowering interventions within 48 hours post-DMEK.
• To assess the efficacy of a standardized surgical approach in preventing complications like pupillary block.

Main Methods:

• Retrospective review of 116 consecutive DMEK procedures with 10% SF6 tamponade and surgical iridectomy.
• Postoperative IOP measured using Goldmann applanation tonometry at 3, 24, and 48 hours.
• Assessment of anterior chamber gas fill and documentation of IOP-lowering interventions (venting, acetazolamide).

Main Results:

• Mean IOP and gas fill remained within normal limits and declined steadily over 48 hours.
• IOP-lowering interventions were required in 9.5% of cases; re-bubbling in 10.3%.
• Glaucoma patients exhibited significantly higher postoperative IOP and required interventions more frequently.

Conclusions:

• A standardized DMEK approach with surgical iridectomy and 10% SF6 tamponade effectively prevents pupillary block.
• Early postoperative IOP and gas fill assessment are vital for timely management of IOP elevation.
• Particular vigilance for IOP management is recommended in patients with pre-existing glaucoma.