Posters

Step-wise approach for multiple graft detachment following DMEK surgery

Poster Details

First Author: E.Livny ISRAEL

Co Author(s): Y. Keshet   Y. Nahum   I. Bahar              

Abstract Details

Purpose:

To describe the results of a step-wise approach for re-attaching partially detached DMEK graft following DMEK surgery, in cases that the first re-bubbling was unsuccessful in attaching the grafts.

Setting:

Ophthalmology department of a tertiary hospital in Israel

Methods:

Interventional case series of 6 patients who underwent DMEK for Fuch's dystrophy (n=1), bullous keratopathy (n=2), failed penetrating keratoplasty (n=2) and PPMD (n=1). In 3 cases, air was used and in 3 cases SF6 was used to attach the graft to the stroma at the end of the surgery. Later, a significant detachment of the graft was observed in all cases, and an attempt to re-attach the graft by SF6 re-bubbling was made. In all cases, the first re-bubbling failed and a significant detachment was still apparent. Then, another re-bubbling, this time using Perfluoropropane (C3F8) gas was performed.

Results:

In all cases, the second re-bubbling with C3F8 gas (which lasts longer than SF6 in the anterior chamber) was successful in reattaching the detached graft. All corneas cleared up in the follow-up period and the vision improved. The endothelial cell count dropped in a comparable fashion to standard DMEK surgeries, except for one case of a patient who had previous trabeculectomy and chronic hypotony.

Conclusions:

C3F8 gas in a 10% concentration (non-expansile concentration) lasts longer than air or SF6 gas in the anterior chamber. This provides longer tamponade and longer bubble support than air or SF6 for DMEK grafts that did not re-attach in the first re-bubbling, thus increasing the likelihood of these grafts to re-attach.

Financial Disclosure:

None