The edition · Ophthalmology
Raised pressure after endothelial keratoplasty is common, and less so after DMEK
A meta-analysis of 5,235 eyes finds ocular hypertension in a third after DSAEK, genetic data flag a possible AMD signal for CETP inhibitors, and an AAO assessment finds injected and sponge mitomycin C equivalent at trabeculectomy.
The edition in brief
A systematic review of 33 studies (5,235 glaucoma-naive eyes) found de novo glaucoma in 3% after DMEK versus 11% after DSAEK, and ocular hypertension in 9% versus 34%, with the difference persisting after allowing for longer DSAEK follow-up; higher steroid exposure was independently linked to ocular hypertension, and certainty was low. Drug-target Mendelian randomisation in UK Biobank and a Singapore cohort found genetically proxied CETP inhibition associated with higher risk of advanced AMD (OR 1.45) in Europeans and of exudative AMD and polypoidal choroidal vasculopathy (OR about 3) in East Asians, a potential safety signal for this cardiovascular drug class. An American Academy of Ophthalmology technology assessment of 11 studies found mitomycin C by injection or sponge at trabeculectomy gave similar pressure control and complications, with injection possibly producing more diffuse blebs. A Kyoto cohort found intraocular pressure in treated glaucoma fell slightly as ambient temperature rose. The pearl: check pressure within weeks of starting topical steroids.
Genetic data link CETP inhibition to higher AMD risk
Genetic evidence suggests CETP inhibition may raise AMD risk; watch for this as these lipid drugs reach practice, without stopping current treatment.
Mitomycin C at trabeculectomy: injection and sponge perform alike
Injected and sponge-applied mitomycin C gave similar pressure control and safety at trabeculectomy; choose by surgeon experience.
Pressure in treated glaucoma ran slightly higher in cold weather
Pressure in treated glaucoma was slightly higher in colder weather; confirm a trend before escalating on a single winter reading.
Topical steroids: check the pressure within weeks
Check intraocular pressure within weeks of starting topical steroids, and regularly while they continue.
After endothelial keratoplasty, plan pressure surveillance: OHT 9% after DMEK, 34% after DSAEK
Build pressure checks into follow-up after endothelial keratoplasty, particularly DSAEK, and tailor steroid potency to limit ocular hypertension.
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