Impact of prior glaucoma surgery on graft survival after
DMEK
: A large retrospective cohort study
Tamara Bilic, Peter Szurman, Warda Darwisch, Dominik Weber, André M. Trouvain, Clara E. Englisch, Berthold Seitz, Annekatrin Rickmann Abstract
Purpose
To evaluate outcomes in glaucoma eyes (G) compared with non‐glaucoma eyes (NG) after Descemet membrane endothelial keratoplasty (DMEK), with a particular focus on the role of prior glaucoma surgery.
Methods
In this retrospective cohort study, 2538 eyes undergoing DMEK were analysed, including 241 glaucoma eyes (G) and 2297 non‐glaucoma eyes (NG). Outcomes included visual acuity, intraocular pressure, endothelial cell loss, rebubbling rate, repeat DMEK, and graft survival. Subgroup analyses were performed comparing treated glaucoma eyes (MG) with surgically treated glaucoma eyes (SG).
Results
G eyes showed worse outcomes compared with NG eyes, including higher endothelial cell loss, increased repeat DMEK rates (14% vs. 6%, p < 0.001), and reduced graft survival (5‐year survival 85.2% vs. 92.1%, p < 0.001). Within G eyes, SG eyes demonstrated poorer graft survival than MG eyes (HR 2.32, p = 0.020). The highest risk was observed in eyes with multiple prior glaucoma procedures.
Conclusion
Glaucoma eyes (G) had worse DMEK outcomes than non‐glaucoma eyes (NG), particularly among surgically treated glaucoma eyes (SG). SG eyes were more strongly associated with endothelial cell loss, repeat DMEK, and graft failure than medically treated glaucoma eyes (MG). These findings may help guide risk stratification and patient counselling, although residual confounding and differences in glaucoma severity cannot be excluded.