- Design
- Systematic review and meta-analysis
- Population
- 5235 glaucoma-naive adult eyes across 33 studies
- Primary outcome
- De novo glaucoma and ocular hypertension
- Effect
- Glaucoma 3% vs 11%; OHT 9% vs 34% (DMEK vs DSAEK); OHT rate ratio 0.31 (0.14 to 0.71)
A systematic review pooled 33 studies, 5235 glaucoma-naive eyes, reporting new glaucoma or ocular hypertension after DMEK or DSAEK.
De novo glaucoma occurred in 3% after DMEK and 11% after DSAEK; ocular hypertension in 9% and 34%; starting or escalating drops in 6% and 20%. DSAEK cohorts were followed twice as long, but adjusted rates still favoured DMEK for ocular hypertension (rate ratio 0.31, 0.14 to 0.71); for glaucoma the interval crossed 1 (0.45, 0.19 to 1.07). Using strict optic nerve or field criteria, the gap narrowed to 5.0% vs 8.1%. Greater steroid exposure was independently associated with ocular hypertension.
The pattern favours DMEK, but part of the difference is probably steroid regimen. Pressure rises after either procedure are common enough to warrant planned IOP checks.
- Check IOP at every post-keratoplasty visit, whichever technique was used.
- Taper topical steroid to the lowest effective dose, and consider a lower-potency steroid after DMEK.
- Counsel DSAEK patients about a higher chance of pressure rise.
- Include glaucoma risk in the choice of technique where both are feasible.
Why it matters
Post-keratoplasty glaucoma threatens both the optic nerve and the graft, and the technique and steroid plan affect it.
Don't overread it
The difference may largely reflect steroid regimens and definitions rather than the technique itself.
The statistics, in plain English
Single-arm pooled rates compare different patients and different follow-up; the head-to-head odds ratio (0.51, 0.22 to 1.21) crosses 1. The certainty was rated low to very low.
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