Anterior Chamber Air Bubble to Achieve Graft Attachment After DMEK

Ćirković, Aleksandar; Beck, Christina M.; Weller, Julia M.; Kruse, Friedrich E.; Tourtas, Theofilos

doi:10.1097/ico.0000000000000753

Cited by 42 publications

(19 citation statements)

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“…Mean endothelial cell counts were 1498 cells/mm 2 and mean central corneal thickness was 503 μm in the study by Tourtas and colleagues, which also is in good agreement with our data. A more recent analysis does not provide information on visual acuity but it does again report comparable results regarding endothelial cell counts and central corneal thickness 18. Rebubbling rates in both our groups are at the lower end of the reported range of a number of previous studies (summarised in ref.…”

Section: Discussionsupporting

confidence: 72%

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Organ-cultured, prestripped donor tissue for DMEK surgery: clinical outcomes

2016

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Section: Discussionsupporting

confidence: 72%

“…Rebubbling rates in both our groups are at the lower end of the reported range of a number of previous studies (summarised in ref. 18). …”

Section: Discussionmentioning

confidence: 99%

Organ-cultured, prestripped donor tissue for DMEK surgery: clinical outcomes

2016

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“…As with other endothelial keratoplasty procedures, the use of air or gas in the anterior chamber (AC) is fundamental to sutureless adherence of the donor graft to the host cornea. Studies suggest that a larger bubble helps prevent graft detachment and rebubbling procedures1,2 whereas gas overfill leads to complications, such as pupillary block3 and raises concern of possible endothelial toxicity 4,5. The ideal gas fill after DMEK to date is unknown and a lack of knowledge of air and gas behavior in the AC hinders optimal surgical results.…”

Section: Introductionmentioning

confidence: 99%

Gas-Graft Coverage After DMEK: A Clinically Validated Numeric Study

Pralits

Alberti

Cabreizo

2019

Trans. Vis. Sci. Tech.

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PurposeWe investigate the influence of positioning, gas fill, and anterior chamber size on bubble configuration and graft coverage after Descemet's membrane endothelial keratoplasty (DMEK).MethodsWe use a mathematical model to study the bubble shape and graft coverage in eyes of varying anterior chamber depths (ACD). The governing equations are solved numericly using the open source software OpenFOAM. Numeric results are validated clinically so that clinical gas fill measures can be correlated with numeric results providing gas-graft coverage information otherwise clinically inaccessible.ResultsIn a phakic eye (ACD = 2.65 mm) with a gas fill of 35%, graft contact ranged from 35% to 38% depending on positioning and increased to 85% to 92% with a 70% fill. In contrast, positioning of a pseudophakic eye (ACD = 4.35) with a gas fill of 35% results in graft contact ranging from 8% to 52%, increasing to 63% to 94% with a 70% fill. The mathematical model demonstrates negligible differences between air and SF6 results and interestingly, a very thin central patch of aqueous humor within the gas bubble is found in some cases.ConclusionsGraft coverage in phakic eyes (ACD ≤ 3 mm) is dominated by the gas fill and less sensitive to patient positioning. In pseudophakic eyes with larger values of ACD, the graft coverage depends on gas fill and patient positioning with positioning even more important as ACD increases.Translational RelevanceAnterior chamber depth markedly influences the role of patient positioning in gas-filled eyes after DMEK due to the interplay between anterior chamber anatomy and gas bubble morphology.

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“…Cirkovi c and associates reported in a series of 74 cases that an air fill of 80% of the anterior chamber was associated with significantly less need for rebubbling than an air fill of 50%, an outcome that is in accordance with our results. 21 However, it must be noticed again that these authors addressed the issue of rebubbling rather than that of graft detachment, which, as previously explained, do not necessarily coincide.…”

Section: Discussionmentioning

confidence: 94%

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Leon¹,

Parekh²,

Nahum³

et al. 2018

American Journal of Ophthalmology

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To evaluate the risk factors for early graft detachment in Descemet membrane endothelial keratoplasty (DMEK). DESIGN: Case-control study. METHODS: PARTICIPANTS: A total of 173 donor corneas and 173 eyes of the patients following DMEK or DMEK in combination with phacoemulsification and intraocular lens implantation were included. INTERVENTION: Prestripped DMEK grafts were transplanted using pullthrough technique. At the end of surgery, the anterior chamber was filled with air, which was removed 3 hours later only if pupillary block was suspected. Rebubbling was performed in all cases with graft detachment, independently of its extension, as documented by means of anterior segment optical coherence tomography. The donor characteristics were collected from the eye bank database and matched with the recipient database. MAIN OUTCOME MEASURES: Donor and recipient characteristics affecting graft detachment using univariate and multivariate analysis. RESULTS: The combination of DMEK with cataract removal and IOL implantation (odds ratio [OR] [ 5.31, 95% confidence interval [CI] 2.03-13.86, P < .002) and air fill of £75% of anterior chamber height at 2-3 hours postoperatively (OR [ 2.66, 95% CI 1.12-6.34, P [ .027) were found to be independent risk factors for postoperative graft detachment. CONCLUSIONS: Cataract removal at the time of DMEK is a risk factor for early graft detachment and therefore sequential surgery may be preferred over combined surgery in an attempt at minimizing rebubbling. Air level in the anterior chamber should be monitored and maintained above 75% in the early hours following surgery.

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Anterior Chamber Air Bubble to Achieve Graft Attachment After DMEK

Abstract: Larger air bubbles of 80% anterior chamber volume decrease the risk of graft detachment after DMEK with no detrimental effect on the outcome and risk for pupillary block.

Cited by 42 publications

References 35 publications

Organ-cultured, prestripped donor tissue for DMEK surgery: clinical outcomes

Organ-cultured, prestripped donor tissue for DMEK surgery: clinical outcomes

Gas-Graft Coverage After DMEK: A Clinically Validated Numeric Study

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