- Design
- Systematic review and meta-analysis of 22 retrospective studies
- Population
- 943 endothelial grafts in eyes with prior glaucoma surgery
- Primary outcome
- Graft survival
- Effect
- 36-month survival 57% overall (48 to 66%); 50% after drainage device (42 to 57%)
A meta-analysis of 22 retrospective studies pooled 943 endothelial grafts (656 DSAEK, 287 DMEK) in eyes with previous glaucoma surgery, with at least six months of follow-up.
Pooled 36-month graft survival was 57% (95% CI 48% to 66%) overall and 50% (42% to 57%) after a glaucoma drainage device. Endothelial cell loss in drainage device eyes reached 53% at 6 months and 63% at 12 months. Dislocation was 19% in drainage device eyes and 15% overall. Rejection was 8% to 9%, primary failure 4% to 5%. DSAEK was numerically favoured from 24 months in indirect comparisons, but head-to-head studies showed no significant difference through 24 months.
These figures should shape consent. A patient with a tube shunt should be told plainly that their graft has roughly even odds of lasting three years, and that a repeat graft is likely.
- Quote graft survival of about 50% at three years to patients with a drainage device.
- Plan for closer endothelial cell count monitoring in the first year.
- Consider DSAEK in drainage device eyes where surgeon experience allows; the evidence is indirect.
- Coordinate IOP control with the glaucoma team before and after keratoplasty.
Why it matters
It gives the first pooled survival figures for a high-risk group where counselling has relied on small series.
Don't overread it
All studies were retrospective, and the DSAEK advantage comes from indirect comparisons only.
The statistics, in plain English
A pooled survival of 50% with an interval of 42% to 57% is fairly precise. Indirect comparisons between techniques mix studies with different patients and surgeons, so they are weaker than head-to-head data.
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