Abstract
Objective To identify the incidence and risk factors for steroid response (SR) in low-risk patients who underwent routine DMEK or phaco-DMEK surgery.
Methods Retrospective review of 1,032 eyes which underwent DMEK surgery or combined phacoemulsification/DMEK surgery (phaco-DMEK) between 01/2014 and 12/2020 was performed and 993 eyes were included. Eyes with pre-existing ocular hypertension, glaucoma or post-operative pupillary block were excluded. Incidence and time to SR onset were determined. Association between onset of SR and agents for graft tamponade (air vs SF6), topical steroids agents and need for re-bubbling were analysed. Treatment outcomes of SR were reported.
Results Overall incidence of SR was 10.8% (107/993) across 7-years, of which 6.8% (67/993) for DMEK alone and 4.0% (40/993) for phaco-DMEK but the difference was not significant (p>0.05). Majority developed within 4–6 months (30.8%), and median time to onset was 4.5 months post-operatively. 95% were still on topical dexamethasone at onset. Re-bubbling increased the risk (OR 1.85, 95% CI 0.07–1.65). There was no statistical difference between air vs SF6 tamponade and risk of SR (p>0.05). Majority (85.0%) responded well to topical intraocular pressure treatment and change of topical steroid formulation without developing glaucoma.
Conclusion Incidence of SR is higher than expected even for low-risk DMEK patients with no pre-existing history of ocular hypertension but majority of these cases responded well to topical treatment. Lower potency steroid formulation should be considered at around 6-months post-operatively in low-risk DMEK grafts. Patients who require DMEK re-bubbling should be monitored more closely for SR.
