Cystoid macular oedema after descemet membrane endothelial keratoplasty

Abstract

AimsTo determine the incidence and risk factors of cystoid macular oedema (CMO) following descemet membrane endothelial keratoplasty (DMEK) with or without combined cataract surgery (triple-DMEK).MethodsWe reviewed the records of patients who underwent DMEK surgery alone or triple-DMEK performed at the Rothschild Foundation Hospital (Paris, France) between January 2019 and March 2020. Patients with pre-existing CMO observed on the preoperative macular optical coherence tomography (OCT) were excluded. Spectral-domain OCT was performed in patients with postoperative visual impairment. Data regarding comorbidities, intraoperative characteristics and postoperative treatments or complications were collected and analysed. Univariate and multivariate analyses were performed.ResultsTwenty three of 246 eyes (9.36%) developed clinically significant (cs)-CMO after DMEK. Triple-DMEK was not associated with a higher risk to develop CMO (12.2% in DMEK alone and 6.1% in triple-DMEK). Pseudophakic bullous keratopathy (PBK ; 39.1% vs 9%; OR=3.5 (1.0 to 11.8), p=0.045) and epiretinal membrane (ERM; 39.1% vs 7.7%; OR=10.5 (3.4 to 32.3), p<0.001) were more frequently observed in patients who developed CMO. The occurrence of hyphaema during surgery was statistically associated with postoperative CMO (13% vs 1.3%; OR=7.1 (1.0 to 48.8) p=0.045). Peroperative epithelial debridement was statistically associated with postoperative CMO (65.2% vs 33.2%, p=0.005), but only in univariate analysis.ConclusionsWe identified a clinically significant CMO incidence of 9.35% after DMEK. Patients with a history of ERM, PBK and intraoperative hyphaema may be at risk of developing CMO after DMEK surgery and should be monitored.

Clinical Outcomes of Transscleral-Sutured Intraocular Lens Combined With Descemet Membrane Endothelial Keratoplasty

“…8 In DMEK, CME has been associated with PBK but not with FECD or triple procedures. 25 Although not statistically significant, the reasons for a trend to higher CME in the TSS-IOL group in this study could be (1) excessive intraocular manipulations lead to increased inflammation, (2) main indication for DMEK surgery in this group was PBK, which has been associated to higher rates of CME, and (3) no topical NSAIDs were routinely used postoperatively.…”

“…Cystoid macular edema can occur in up to 9.36% to 12.5% of cases after endothelial keratoplasty. 25 In a study comparing DSAEK with TSS-IOL implantation and DSAEK alone, a higher incidence of CME was observed in the TSS-IOL group. 8 Furthermore, after standalone IOL repositioning, the incidence of CME can be as high as 17%.…”

Outcomes of cystoid macular edema following Descemet’s membrane endothelial keratoplasty in a referral center for keratoplasty in Spain: retrospective study

“…In our study, there was a relatively high proportion of non-FECD eyes, including two redo DMEK eyes, suggesting that indications other than FECD may represent a risk factor for vs-CMO. In several studies reporting CMO after EK (but not all), a relatively high proportion of cases occurred in non-FECD eyes 4,9,24 , and previous studies have reported that glaucoma-related corneal endothelial dysfunction, and PPBK were risk factors for CMO after EK 7,17,18 ; however, whether indication for DMEK is a risk factor for postoperative CMO remains unclear 3,4,9 .…”

Intravitreal dexamethasone to manage post endothelial keratoplasty cystoid macular oedema refractory to topical therapy

“…The management of post cataract surgery CMO with topical steroids and nonsteroidal agents has been conventionally applied as a treatment approach for post EK CMO on the assumption it behaves in the same way, although no studies have compared strategies for managing cases refractory to topical therapy. 12,13 Other treatment modalities reported include the use of topical steroid with oral acetazolamide, 8,14–16 sub-Tenon's triamcinolone acetonide, 5 Click or tap here to enter text., and subconjunctival methylprednisolone. 17 For persistent cases, intravitreal anti-vascular endothelial growth factor (anti-VEGF) therapy and intravitreal steroid have been described.…”