Intraocular pressure changes following Descemet's stripping with endothelial keratoplasty

Purpose: To evaluate the postoperative changes in intraocular pressure (IOP) following Descemet's stripping with endothelial keratoplasty (DSEK). Methods: A retrospective chart review of 45 eyes that underwent DSEK for the treatment of corneal edema induced by aphakic or pseudophakic bullous keratopathy (ABK/PBK) and Fuchs' endothelial dystrophy. A mean baseline IOP was obtained at three different preoperative visits using Tono-Pen® XL tonometer. This baseline pressure was compared to IOPs obtained at postoperative months 1, 3, 6 and 12. Results: Intraocular pressure increased from a mean preoperative value of 15.6 ± 4.2 mmHg to 15.9 ± 5.8 mmHg in the first postoperative month; 17.0 ± 5.7 mmHg at 3 months; 18.1 ± 6.2 mmHg at 6 months and 16.8 ± 4.7 mmHg at 1 year. These pressure differences were considered statistically significant, p = 0.0074 (repeated measures ANOVA). Eyes diagnosed with ABK/PBK (n = 20) showed a significant rise in IOP only noted after the 3^rd month that peaked at 6 months, p = 0.0001 (repeated measures ANOVA). A subgroup of patients with a diagnosis of Fuchs' endothelial dystrophy (n = 25), showed no statistically significant changes in IOP at 1 year follow-up; p = 0.9103 (repeated measures ANOVA). In a subgroup of eyes with a diagnosis of glaucoma or ocular hypertension (n = 13), a statistically significant increase in IOP was noted after 1 year of follow-up. Mean IOP raised from a preoperative mean value of 16.0 ± 3.7 mHg to 19.0 ± 5.3 mmHg at 1 year; p = 0.0074 (repeated measures ANOVA). Conclusions: DSEK induced statistically significant IOP increases in the early postoperative period with a tendency to higher pressures after the 3^rd month of follow-up. Patients with a preoperative diagnosis of Fuchs' endothelial dystrophy did not show a statistically significant increase in IOP compared to a baseline mean preoperative value. The difference between statistically significant and clinically significant IOP increase is yet to be established.