Rebubbling Rate Higher in DMEK Than DSAEK in Patients With Glaucoma Implant

Patients with an Ahmed valve implant may fare better with DSAEK than DMEK.

The rebubbling rate for patients with an Ahmed valve implant is higher following Descemet membrane endothelial keratoplasty (DMEK) compared with Descemet-stripping automated endothelial keratoplasty (DSAEK), according to research presented at the American Society of Cataract and Refractive Surgery 2023 annual meeting, held in San Diego, CA, from May 5 to 8, 2023.1

Presenters at the ASCRS conference retrospectively reviewed records of patients who underwent Ahmed glaucoma valve implementation and later received either DSAEK (n=18) or DMEK (n=15) between January 2018 and December 2021, as they wanted to compare early prognosis.

The researchers compared the patients’ best corrected visual acuity (BCVA), intraocular pressure (IOP), endothelial cell density (ECD), re-bubbling, early graft rejection, IOP elevation, and macular edema. Analysis was conducted with independent t-test, Pearson correlation, and regression analysis. They also monitored patients’ rebubbling rate, instances of early graft rejection, IOP elevation, and macular edema.

Although further study is needed, DSAEK might be preferred to DMEK in patients with Ahmed valve implant.

The DSAEK group had higher mean ECD (P =.017). The groups’ ECD loss wasn’t statistically significantly different at 1 week, 1 month, 3 months, or 6 months. Donor age was a dependent factor of both groups’ ECD loss. The rebubbling rate was higher with with DMEK (P =.035), but rebubbling was not a significant risk factor of early graft rejection.

“Although further study is needed, DSAEK might be preferred to DMEK in patients with Ahmed valve implant,” according to the researchers.

A study published in Cornea in November 2022 indicated challenges in DMEK graft preparation didn’t significantly impact postoperative clinical outcomes in patients at 1 year.2 Researchers who conducted long-term follow-up of DMEK compared with DSAEK in fellow eyes found that best spectacle-corrected visual acuity (BSVA) and patient satisfaction were comparable, but DMEK eyes reached BSVA more quickly, according to a study published in the American Journal of Ophthalmology in June 2021.3

Limitations of the study included its retrospective nature and small sample size.


  1. Song J, Yoon HY, Chung SH, et al. Comparison of prognosis between DSAEK and DMEK in eyes with previous Ahmed valve implant glaucoma surgery. Poster presented at: American Society of Cataract and Refractive Surgery 2023; May 5-8, 2023; San Diego, CA. Poster 91472.
  2. Schrittenlocher S, Matthaei M, Rokohl A, et al. Influence of Descemet membrane endothelial keratoplasty graft preparation patterns on postoperative clinical outcomeCornea. Published online November 21, 2022. doi:10.1097/ICO.0000000000003141
  3. Weisenthal RW, Yin HY, Jarstad AR, Wang D, Verdier DD. Long term outcomes in fellow eyes comparing DSAEK and DMEK for treatment of Fuchs corneal dystrophy. Am J Ophthalmol. Published online June 19, 2021. doi:10.1016/j.ajo.2021.06.013