Incidence of Cystoid Macular Edema After Descemet Membrane Endothelial Keratoplasty

Abstract

Purpose:The incidence of and risk factors for cystoid macular edema (CME) after Descemet membrane endothelial keratoplasty (DMEK) remain uncertain. This study examines the incidence of and risk factors for CME after DMEK.Methods:This retrospective, single-center study included patients with no history of CME who had undergone DMEK. Patients were examined weekly for 1 month after surgery and at 3 and 6 months after surgery. Follow-up examinations included visual acuity (VA) assessment, pachymetry, anterior segment optical coherence tomography, biomicroscopy, intraocular pressure measurement, and fundoscopy. Eyes suspected of having CME (reduced VA and/or abnormal fundoscopic findings) underwent macular optical coherence tomography. Potential risk factors for CME examined included age, axial length, anterior chamber rebubbling, not using a topical nonsteroidal antiinflammatory after surgery, and concurrent DMEK and cataract surgery (triple-DMEK).Results:Eighty eyes (74 subjects) were included. Eleven eyes (13.8%) developed CME within 6 months after undergoing DMEK. Univariate analyses did not identify any significant CME risk factors. Interestingly, the triple-DMEK procedure did not put subjects at risk for developing CME (P = 0.184). Visual prognosis after medical treatment for CME was excellent, and subjects with and without CME had comparable VA at 6 months [CME: logarithm of the minimum angle of resolution (logMAR) VA = 0.3 (first–third quartile: 0.1–1.0), 20/40; no CME: logMAR VA = 0.3 (0.1–0.5), 20/40; P = 0.391].Conclusions:Although CME frequently occurred after DMEK, no CME risk factors were identified. In addition, CME did not significantly affect long-term visual outcomes when it was appropriately treated.

Risk Factors for Cystoid Macular Edema After Descemet Membrane Endothelial Keratoplasty

“…The incidence of CME reported here was higher than that previously reported in Caucasian eyes (7%–13.8%). 4–7 The increase in CME incidence might be attributed to the difference in etiology. As we previously reported, 8 bullous keratopathy from argon laser iridotomy, pseudoexfoliation syndrome, or pseudophakic bullous keratopathy are leading etiologies of DMEK in Japan, whereas the proportion of FECD is relatively lower than that in Western countries.…”

“…1,2 This complication can be observed after different ocular surgeries, including DMEK. 3–7 Recent studies using spectral domain optical coherence tomography (SD-OCT) have shown that the incidence of CME after DMEK is 7% to 13.8%. 4–7 Therefore, Heinzelmann et al 4 recommended regular SD-OCT monitoring during the first 6 months after DMEK.…”

“…3–7 Recent studies using spectral domain optical coherence tomography (SD-OCT) have shown that the incidence of CME after DMEK is 7% to 13.8%. 4–7 Therefore, Heinzelmann et al 4 recommended regular SD-OCT monitoring during the first 6 months after DMEK. Conversely, Hoerster et al 5 reported that hourly early postoperative topical steroid therapy was very effective in reducing the incidence of CME after DMEK.…”

<p>Macular edema associated with non-infectious uveitis: pathophysiology, etiology, prevalence, impact and management challenges</p>

“…MΕ following penetrating keratoplasty is a common complication but recently with the development of new endothelial grafting techniques (Descemet’s stripping endothelial automated keratoplasty and Descemet’s membrane endothelial keratoplasty), which are supposed to be less invasive, their incidence has increased 125,126. Keratoplasty-related ME, usually, resolves spontaneously or with topical anti-inflammatory treatment alone, within a few weeks, without affecting the final visual outcome of patients 125–127…”

Effects of uncomplicated Descemet membrane endothelial keratoplasty on the central retinal thickness

“…Common complications of the early postoperative period following DMEK surgery are transplant detachment (4.0-34.6%) [14][15][16], early postoperative failure (1.4-5.0%) [5,17], and macular edema (DMEK-ME, 1.0-15.6%) [18][19][20][21][22][23], the latter peaking between 1 and 3 months after surgery [18][19][20][21]23].…”