Name

Facteurs de risque d'oedème maculaire cystoïde après greffe lamellaire endothéliale

Purpose: To determine the incidence and risk factors of cystoid macular edema (CME) following Descemet membrane endothelial keratoplasty (DMEK) with or without combined cataract surgery (triple-DMEK). 

Design: Retrospective cohort study

Setting: Rothschild Foundation Hospital, Paris, France

Methods: We reviewed the medical records of patients that underwent DMEK surgery alone or triple-DMEK performed between January 2019 and March 2020. Patients with pre-existing CME 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 analyzed. 

Twenty three of 246 eyes (9.35%) developed CME after DMEK. Triple-DMEK was not associated with a higher risk to develop CME (13.2% in DMEK alone and 5.0% in triple-DMEK). Pseudophakic bullous keratopathy (PBK) and epiretinal membrane (ERM) were more frequently observed in patient that developed CME (39.1% vs 9%, P = .003 ; and 39.1% vs 7.7%; P = .001, respectively). Patients that developed CME had a significantly lower visual acuity before (0.82 vs 0.52 LogMAR ; P = .005) and 3 months after the surgery (0.40 vs 0.16 LogMAR ; P = .005). The occurrence of hyphema during surgery and epithelial debridement were statistically associated with postoperative CME (13% vs 1.3%, P = .005; 65.2% vs 33.2%, P = .004).

The incidence of CME after DMEK in our study is consistent with recent studies in the literature. The incidence of CME after DMEK found in the literature since 2014 ranges from 1.0% (1) to 15.6% (2). Our study identified several risk factors for CME development after DMEK, some confirms previously reported factors while others have not yet been described, namely peroperative epithelial debridement, ERM, PBK, or vision impairment preceding surgery. Our study had some limitations being a retrospective design.

We identified a postoperative CME incidence of 9.35%. Patients with a history of ERM, PBK, intraoperative hyphema or epithelial debridement may be at risk of developing CME after DMEK surgery and should be monitored closely.