Clinical outcome of rebubbling for graft detachment after Descemet's membrane endothelial keratoplasty (DMEK)

Session Details

Session Title: Cornea: Surgical I

Session Date/Time: Sunday 08/10/2017 | 10:30-12:30

Paper Time: 11:28

Venue: Meeting Center Room I

First Author: : L.Ham THE NETHERLANDS

Co Author(s): :    L. Baydoun   S. Oellerich   N. Gerber-Hollbach   I. Dapena   V. Liarakos   G. Melles     

Abstract Details

Purpose:

To assess the clinical outcome after successful re-bubbling procedures for visually significant graft detachment after Descemet membrane endothelial keratoplasty (DMEK).

Setting:

Netherlands Institute for Innovative Ocular Surgery / Tertiary referral center.

Methods:

From a total of 760 consecutive DMEK surgeries, 41 eyes required re-bubbling of which 33 were successful and were included in our retrospective outcome analysis study. Main outcome measures were compared to matched controls with uneventful primary DMEK (attached DMEK grafts without re-bubbling). Re-bubbling was on average performed 25 (±20) days (range 7-91 days) after DMEK. All eyes were evaluated for best-corrected visual acuity (BCVA), endothelial cell density (ECD), pachymetry, and complications up to 6 months after re-bubbling.

Results:

At six months after DMEK, BCVA in re-bubbled eyes did not differ from that in control eyes (P=.514). Mean ECD decrease was higher in re-bubbled than in control eyes (54% versus 35% respectively, P=.001). Pachymetry did not differ between both groups (P=.153). After re-bubbling, one buphthalmic eye showed a temporary intraocular pressure elevation and five eyes had minor graft edge detachments that did not require further treatment.

Conclusions:

Re-bubbling for DMEK graft detachment may give similar visual outcomes as in uncomplicated DMEK, when performed within the first 6-8 postoperative weeks. However, re-bubbled eyes may show lower ECD, which may be attributed to additional air bubble trauma and/or selection bias through more extensive manipulation during the initial DMEK or higher risk of graft detachment in more complicated eyes.

Financial Disclosure:

receives consulting fees, retainer, or contract payments from a company producing, developing or supplying the product or procedure presented