The need of rebubbling in case of small graft detachments after Descemet Membrane Endothelial Keratoplasty (DMEK). Issue 3 (May 2023)

• Record Type: Journal Article
• Authors: Kramer, Nane; Unterlauft, Jan Darius; Girbardt, Christian
• Is Part Of: European journal of ophthalmology. Volume 33:Issue 3(2023)
• Page Start: 1347
• Page End: 1353
• Publication Date: 2023-05
• Subjects: Descemet membrane endothelial keratoplasty -- DMEK -- rebubbling -- graft detachment -- graft adherence; Ophthalmology -- Periodicals; Eye -- Diseases -- Periodicals; 617.7005
• DOI: 10.1177/11206721221146579
• Languages: English
• ISSNs: 1120-6721

Abstract

Purpose: To investigate the need of rebubbling for small graft detachments after Descemet Membrane Endothelial Keratoplasty (DMEK). Methods: In this retrospective study we evaluated 111 eyes from 111 patients that showed graft detachment after DMEK surgery and have achieved graft adherence by injection of air or 20% sulfur hexafluoride (SF6 ) to the anterior chamber (rebubbling group; n = 57) or by spontaneous adherence without intervention (control group; n = 54) at final examination. Subgroups in terms of the maximum height and in terms of the detachment area in relation to graft area were formed. Outcome measures were the increase in best-corrected visual acuity (BCVA) and the decrease in central corneal thickness (CCT) from the measurement before DMEK to six months after surgery and postoperative endothelial cell density. Results: BCVA increased in the rebubbling group and the control group, the difference being 0.22 logMAR, p = 0.048. For eyes with a maximum height less than 500 µm, the increase of BCVA was 0.39 ± 0, 36 logMAR in the control group and 0.62 ± 0, 53 logMAR in the rebubbling group, p = 0.045. There was no difference of statistical significance of BCVA between both groups regarding the detachment area of less than 20% in relation to graft area. The mean decrease in CCT and postoperative endothelial cell density showed no significant difference between the rebubbling group and the control group. Conclusion: Compared to spontaneous graft adherence, a rebubbling shows no beneficial effect on the clinical outcome for small detached DMEK grafts. Rebubbling does not decrease postoperative endothelial cell density.