- Design
- Systematic review and random-effects meta-analysis
- Population
- 33 studies, 5,235 glaucoma-naive adult eyes after DMEK or DSAEK
- Primary outcome
- Incidence of de novo glaucoma and ocular hypertension
- Effect
- Glaucoma 3% vs 11%; ocular hypertension 9% vs 34%; head-to-head OR 0.51 (0.22-1.21)
A systematic review of 33 studies and 5,235 adult eyes without pre-existing glaucoma (American Journal of Ophthalmology, 22 September 2026) pooled the incidence of de novo glaucoma and ocular hypertension after DMEK and DSAEK.
Pooled incidence was 3% vs 11% for de novo glaucoma, 9% vs 34% for ocular hypertension, and 6% vs 20% for starting or escalating pressure-lowering treatment, favouring DMEK. Glaucoma surgery was 1.0% vs 2.5%, not significantly different. DSAEK studies were followed about twice as long, but rate ratios adjusted for time still favoured DMEK for ocular hypertension (0.31, 95% CI 0.14-0.71). With a strict optic-nerve or field definition, glaucoma was 5.0% vs 8.1% and no longer significant. Greater steroid exposure was independently associated with ocular hypertension, and head-to-head comparisons were not significant (OR 0.51, 0.22-1.21). Certainty was low to very low.
Pressure rises after endothelial keratoplasty are common with either technique, and steroid regimens are part of the story.
- Monitor intraocular pressure closely after any endothelial keratoplasty.
- Expect fewer pressure problems after DMEK, but do not reduce surveillance because of it.
- Review the steroid regimen when pressure rises; steroid exposure was linked to ocular hypertension.
- Count post-keratoplasty glaucoma risk among the factors when choosing technique.
Why it matters
It gives surgeons technique-specific numbers for counselling and surveillance planning.
Don't overread it
Head-to-head evidence was non-significant and certainty low; steroid regimens and glaucoma definitions confound the comparison.
The statistics, in plain English
Pooled single-arm rates compare different groups of studies, not the same patients. The head-to-head odds ratio of 0.51 with a CI crossing 1.0 is the fairer comparison, and it is inconclusive.
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