While different types of corneal transplants continue to be explored, a new study in the Journal of Glaucoma suggests endothelial keratoplasty may have some benefits over more standard penetrating keratoplasties.

“We found that endothelial keratoplasties had decreased postoperative intraocular pressures and steroid needs compared with penetrating keratoplasties,” says researcher Priscilla Q. Vu, MD, MS.

However, the incidence of glaucoma surgery and need for IOP-lowering drops were similar between the groups, she adds.

“Because glaucoma is a leading cause of irreversible vision loss after corneal transplantation, we hope that our study adds to the growing knowledge about the risks and benefits of these different corneal transplantation techniques,” Dr. Vu says.

Her team’s investigation was a retrospective chart review of 239 eyes, which included all penetrating keratoplasties (PKP, 127), Descemet’s membrane endothelial keratoplasty (DMEK, 46) and Descemet’s stripping automated endothelial keratoplasty (DSEK, 66) surgeries performed between 2012 and 2017 at University of California, Irvine. 

Patients were excluded if they had a prior history of glaucoma, corneal or glaucoma surgery, concurrent major or emergent surgery, active infection, and eye disease with synechiae. The study compared IOP, steroid and IOP-lowering drop use and the need for glaucoma surgery postoperatively on day one, week one, one month and 24 months.

The researchers found IOP in PKP patients was higher than DMEK and DSEK individuals at all time points. At 12 months, IOP in the PKP group was higher than individuals who had the DMEK procedure.

Other key finding included:

  • IOP was about the same in the DMEK and DSEK groups for all time points.
  • PKP required more steroids than DMEK and DSEK at months three, six, 12 and 24.
  • More IOP-lowering drops were required for DSEK than DMEK and PKP at day one and week one.
  • More IOP-lowering medications were used for DSEK than DMEK at three and 12 months.
  • About 6% to 7% of patients needed glaucoma surgery by 24 months.

Vu PQ, Aggarwal S, Lu Y, et al. Comparison of intraocular pressure, usage of topical steroids, need for intraocular pressure lowering drops, and incidence of glaucoma surgery up to two years after penetrating keratoplasty and endothelial keratoplasty. J Glaucoma. August 20, 2020. [Epub ahead of print].