Role of Initial Intraocular Pressure in Graft Adhesion After Descemet Membrane Endothelial Keratoplasty

Purpose: To analyze the role of initial intraoperative intraocular pressure (IOP) in graft adhesion in Descemet membrane endothelial keratoplasty (DMEK) during early follow-up. Methods: This retrospective, observational, single-center case series included 118 eyes from 118 consecutive patients treated between May and July 2015 for DMEK or combined DMEK and phacoemulsification (triple-DMEK). Exclusion criteria were previous eye surgery other than cataract surgery, loss of follow-up, any application of IOP-lowering medication before and after surgery, and low intraindividual repeatability of IOP measurements. The main outcome measure was graft adhesion that was correlated to the magnitude of IOP measured by Schiotz tonometry intraoperatively. Results: Fifty-four eyes of 118 (45.8%) patients undergoing DMEK met the above-mentioned inclusion and exclusion criteria. In 43 (79.6%) eyes, complete graft adhesion was achieved at 1-week follow-up examination. Differences of the initial IOP in the presence of the air bubble were not statistically significant between eyes with complete and incomplete graft adhesion. Conclusions: Incomplete graft adhesion during early follow-up could not be associated with the magnitude of the initial IOP in DMEK. We found no evidence that higher IOP values enhance graft adhesion resulting in lower rebubbling rates after DMEK.