CME After Keratoplasty

DMEK may carry a higher risk of postoperative CME compared to DSAEK. Roibeard Ó hÉineacháin reports.

Roibeard O’hEineachain

Posted: Thursday, July 1, 2021

Eyes that undergo Descemet’s membrane endothelial keratoplasty (DMEK) appear to have a higher rate of cystoid macular oedema (CME) compared to eyes that undergo Descemet-stripping automated endothelial keratoplasty, following endothelial keratoplasty, according to a study presented by Luca Furiosi MD at the 25th ESCRS Winter Meeting.

“Ages older than 67 years, diabetes, and DMEK are independent risk factors for CME following endothelial keratoplasty. Close observation is necessary, especially during the first postoperative year after EK—particularly in patients with a risk for CME,” said Dr Furiosi, University of Ferrara, Ferrara, Italy.

The study reviewed outcomes of 2,233 patients who underwent endothelial keratoplasty at Ospedali Privati Forlì “Villa Igea”, Forlì, Italy. Of that group, 1,909 patients underwent DSAEK from January 2005 to October 2018 and 324 patients underwent DMEK from June 2014 to August 2018. All had a minimum follow-up of 18 months. In patients undergoing keratoplasty bilaterally, a single eye was chosen at random for inclusion in the analysis, Dr Furiosi said.

Defining CME as the presence of intraretinal fluid spaces with or without subretinal fluid that impairs vision, the researchers found the overall incidence of postoperative CME was 2.82% (63 patients). However, CME occurred in only 2.36% of DSAEK-treated eyes compared to 5.56% of DMEK eyes (p=0.001). There was an average of 4.27 months (range 1–34 months) between the keratoplasty procedure and the onset of CME postoperatively.

Dr Furiosi noted that compared to those who did not develop CME, patients who developed CME were significantly older (70.5 vs. 67.1, p=0.01), the group had a significantly higher proportion of diabetic patients (24.2% vs. 9.8%, p<0.001), and a significantly higher proportion of patients that underwent DMEK rather than DSAEK (28.6% vs. 14.1%, p=0.001). However, there was no significant difference between the non-CME group and the CME group in terms of gender, surgical indication, lens status, rebubbling, concurrent glaucoma, or combined procedures. A receiving operator curve analysis indicated that the age of more than 67 years was the ideal cut-off point for separating non-CME cases from CME cases. A patient with all three risk factors—age, diabetes, and DMEK—had an odds ratio of 16.75 of developing CME with a fitted probability of 18%, Dr Furiosi said. He added that despite the inclusion of all indications for surgery such as previous grafts, the post-DMEK CME rate of 5.56% is in the lower end of range of the 0.7 to 15.6% rates reported in the literature, but was roughly in line with CME rates reported in other studies.

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