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Comparison of clinical outcomes of preloaded vs prestripped vs surgeon-prepared Descemet’s membrane endothelial keratoplasty (DMEK) grafts
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First Author: L.Pagano ITALY
Co Author(s): M. Titley K. Gadhvi G. Coco A. Hulpus V. Romano
Abstract Details
Purpose:
To investigate short and long term outcomes of preloaded DMEK grafts in comparison with prestripped and surgeon harvested ones.
Setting:
St. Paul’s Eye Unit, The Royal Liverpool and Broadgreen Hospital NHS Trust, Liverpool, UK
Methods:
Retrospective UK data of 92 eyes (78 patients) undergoing DMEK with or without concurrent cataract surgery from 2017 to 2019 were included in this review. Characteristics analyzed included type of graft harvesting, graft quality characteristics, graft diameter, type of procedure (combined with phacoemulsification or not), reason for graft, final best corrected visual acuity (BCVA), speed of recovery, graft detachment and rebubbling rate.
Results:
42 eyes had surgeon prepared DMEK graft, 19 prestripped and 31 preloaded grafts. Rebubbling rate was significantly lower in the surgeon prepared group vs the other two (14.29% vs 42.11% vs 48.39%, p<0.01).
37 eyes had DMEK surgery alone, while 55 had phaco DMEK. Combined cataract surgery proved to be an additional risk factor for rebubbling (43.64% vs 13.51%, p<0.01)
These two factors proved to be independent risk factor in a multivariate regression model (p<0.01).
Visual outcomes were comparable among groups (p=0.8).
Conclusions:
Rebubbling rate was significantly higher when using a preloaded graft and when the graft was combined with cataract surgery.
The conservation fluid might reduce the attachment capabilities of preloaded grafts, when compared to a freshly harvested tissue. Furthermore, combining DMEK with phaco can further reduce the graft adhesion, by inducing more surgical trauma and inflammation in the anterior chamber.
However, final visual acuity was not influenced by the rebubbling procedure.
Financial Disclosure:
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