A systematic review and meta-analysis of 33 studies (5,235 eyes) pooled the incidence of de novo glaucoma and ocular hypertension in glaucoma-naive adults after DMEK versus DSAEK. Pooled incidence favored DMEK for de novo glaucoma (3% vs 11%), ocular hypertension (9% vs 34%), and medication initiation/escalation (6% vs 20%), with the pattern persisting after adjusting for follow-up duration, though glaucoma surgery rates did not differ significantly. The authors note certainty was low to very low, with confounding by steroid exposure, variable glaucoma definitions, and randomized evidence limited to ultrathin or microthin DSAEK.
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