Related Experiment Video
Updated: Sep 14, 2026
Full-Field Optical Coherence Microscopy for Histology-Like Analysis of Stromal Features in Corneal Grafts
Published on: October 21, 2022
ENDOTHELIAL KERATOPLASTY IN EYES WITH PREVIOUS GLAUCOMA SURGERY: A SYSTEMATIC REVIEW AND META-ANALYSIS STRATIFIED BY
Cristina Irigoyen-Bañegil1, Macarena Jiménez-Alfaro2, Miguel Naveiras1
1Clínica Universidad de Navarra, Pamplona, Spain; Clínica Universidad de Navarra, Madrid, Spain.
Topic:
To pool estimates of graft survival, endothelial cell loss, and complication rates following endothelial keratoplasty (EK) in eyes with prior glaucoma surgery, and to compare outcomes between Descemet stripping automated endothelial keratoplasty (DSAEK) and Descemet membrane endothelial keratoplasty (DMEK).
Clinical Relevance:
EK after glaucoma surgery carries elevated graft failure risk, yet existing series are small, heterogeneous, and individually insufficient to guide risk counselling or technique selection. No pooled synthesis exists to date.
Methods:
Systematic review and meta-analysis (PROSPERO CRD420251118709) searching PubMed/MEDLINE, Scopus, Cochrane, and Web of Science to April 2026. Eligible studies reported DSAEK or DMEK outcomes in eyes with prior glaucoma surgery with minimum 6-month follow-up. Primary outcome was graft survival, extracted from Kaplan-Meier curves where necessary. Secondary outcomes included endothelial cell density, endothelial cell loss, graft dislocation, rejection, and primary graft failure, analyzed using a random-effects model with Freeman-Tukey transformation for proportions. Head-to-head risk ratios were pooled from studies reporting both techniques.
Results:
Twenty-two retrospective studies (943 grafts; 656 DSAEK, 287 DMEK) were included. Pooled 36-month graft survival was 57% (95% CI, 48-66%) in the overall cohort and 50% (95% CI, 42-57%) in eyes with prior glaucoma drainage device (GDD) implantation. Indirect technique-stratified estimates numerically favored DSAEK from 24 months, particularly in GDD eyes. Head-to-head analysis found no significant difference through 24 months in the overall cohort. Pooled endothelial cell loss reached 53% at 6 months and 63% at 12 months in GDD eyes. Graft dislocation was higher in GDD eyes (19%) than in the overall cohort (15%). Rejection rates were 8-9%, and primary graft failure remained low (4-5%).
Conclusion:
Only half of GDD eyes retain a functioning graft at 36 months. Prospective registries with standardized endpoints are needed.
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