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Rebubbling and graft detachment in Descemet membrane endothelial keratoplasty using a standardised protocol

Eye volume 37, pages 2494–2498 (2023)Cite this article

Subjects

Abstract

Objectives

To analyse risk factors and long-term outcomes after rebubbling and graft detachment in Descemet membrane endothelial keratoplasty (DMEK).

Methods

176 consecutive DMEK grafts of 125 patients performed by 8 surgeons with a standardised technique between January 2015 and July 2022 were analysed. Main outcome measures were graft detachments, rebubbling rate, postoperative outcomes, and risk factors for graft failure and rebubbling.

Results

6 (3.4%) grafts required rebubbling (>1/3 area detached). 40 (22.7%) grafts developed self-resolving partial detachments (<1/3 area detached). The mean time to rebubble was 16 ± 9.4 days. Mean BSCVAs at 5 years postoperative were 0.03 ± 0.16, 0.03 ± 0.14, and 0.15 ± 0.31 logMAR in fully attached, partially detached and rebubbled grafts (P = 0.437). 5-year graft survival were 98%, 90%, and 83% in fully attached, partially detached and rebubbled eyes (P = 0.02). There was significantly greater endothelial cell loss (ECL) in the rebubbled eyes (P = 0.018). Intraoperative trauma was a risk factor for graft failure (HR 1.81; 95% CI: 1.33–2.50; P = 0.023). An indication for surgery other than Fuchs endothelial dystrophy was a risk factor for rebubbling (HR 5.28; 95% CI: 5.11–72.4; P = 0.007).

Conclusion

DMEK grafts had better graft survival if there was no partial detachment or rebubbling at 5 years postop. There was significant ECL associated with rebubbling. A standardised technique reduces rebubbling and graft failure risk.

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Fig. 1: Graft survival for fully attached, partially detached (less than 1/3 detached) and rebubbled (more than 1/3 detached) DMEK grafts.
Fig. 2: Preoperative donor ECD and mean ECD during follow-up for fully attached, partially detached, and rebubbled DMEK grafts.

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Data availability

The datasets generated during and/or analysed during the current study are available from the corresponding author on reasonable request.

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Authors and Affiliations

  1. Department of Ophthalmology, King’s College Hospital NHS Foundation Trust, Denmark Hill, London, SE5 9RS, UK

    Lanxing Fu & Emma J. Hollick

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LF was responsible for study conception, analysing data, interpreting results, and drafting the manuscript. EJH was responsible for study design, reviewing and providing feedback on the manuscript.

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Correspondence to Emma J. Hollick.

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Fu, L., Hollick, E.J. Rebubbling and graft detachment in Descemet membrane endothelial keratoplasty using a standardised protocol. Eye 37, 2494–2498 (2023). https://doi.org/10.1038/s41433-022-02362-2

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