Clinical Outcome of Rebubbling for Graft Detachment After Descemet Membrane Endothelial Keratoplasty

Gerber-Hollbach, Nadine; Baydoun, Lamis; López, Ester Fernández; Frank, Laurence E.; Dapena, Isabel; Liarakos, Vasilios S.; Schaal, Sontje-Chiao; Ham, Lisanne; Oellerich, Silke; Melles, Gerrit R.J.

doi:10.1097/ico.0000000000001220

Cited by 56 publications

(44 citation statements)

References 30 publications

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“…Of note, all rebubblings performed in this study were performed within one month after DMEK. This is in accordance to a recent published study investigating the clinical outcome after rebubbling for graft detachment after DMEK in a series of 760 DMEK surgeries with forty-one eyes requiring rebubbling 25. The authors concluded that visual outcomes may be similar to uncomplicated DMEK when rebubbling is performed within the first six to eight weeks after surgery.…”

Section: Discussionsupporting

confidence: 90%

Outcome of Descemet membrane endothelial keratoplasty for graft failure after Descemet stripping automated endothelial keratoplasty

Shajari¹,

Slavík-Lenčová²,

Kohnen³

et al. 2019

OPTH

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Purpose To investigate the efficacy and safety of Descemet membrane endothelial keratoplasty (DMEK) for corneal decompensation following primary Descemet stripping automated endothelial keratoplasty (DSAEK). Methods This was a retrospective case series of 15 patients that underwent DMEK surgery for corneal decompensation after failed DSAEK. Main outcome parameter was corrected distance visual acuity (CDVA) after DMEK and DSAEK. Secondary outcome measures included central corneal thickness (CCT), endothelial cell density (ECD), rebubbling rate, and primary graft failure after DMEK. Explanted DSAEK grafts were evaluated by light microscopy. Results The mean (±SD) time period between DSAEK and DMEK surgery was 15±8 months (range, 6–31 months). Preoperative CDVA was 1.72±0.62 (logMAR). After DMEK, CDVA improved significantly to 0.78±0.48 at 1 month and to 0.23±0.24 after 12 months ( P =0.022). Visual acuity data after DMEK were significantly better compared to preoperative values. The average CCT after DMEK decreased significantly from 869±210 µm (preoperative) to 505±45 µm (1 month postoperative) ( P <0.001) and remained stable over 12 months. The ECD decreased from 2,589±209/mm 2 (preoperative) to 1,691±589/mm 2 (12 months postoperative). Rebubbling DMEK was required in three patients (=20%). Conclusion DMEK represents a feasible and safe procedure in achieving better functional results compared to DSAEK. Visual acuity and optical quality can be effectively reestablished after unsuccessful primary DSAEK surgery even in patients with long-standing corneal decompensation. Further investigations are required to validate the preliminary clinical findings.

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Section: Discussionsupporting

confidence: 90%

Outcome of Descemet membrane endothelial keratoplasty for graft failure after Descemet stripping automated endothelial keratoplasty

Shajari¹,

Slavík-Lenčová²,

Kohnen³

et al. 2019

OPTH

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“…This may be the case by inconvenient recipient's properties like a shallow anterior chamber and the presence of vitreous pressure [6]. The endothelial cell loss of 35% after 6 months in our study was comparable to previous studies [16, 20, 21].…”

Section: Discussionsupporting

confidence: 86%

“…At the 6-month follow-up, only one eye required re-bubbling and none of the patients required repeated DMEK. Of note, our re-bubbling rate was very low compared to rates between 5.4% and 23% reported in other studies [16, 17].…”

Section: Discussioncontrasting

confidence: 80%

How to Avoid an Upside-Down Orientation of the Graft during Descemet Membrane Endothelial Keratoplasty?

Wasielica‐Poslednik

Schuster

Rauch

et al. 2019

Journal of Ophthalmology

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Purpose. Incorrect anterior-posterior orientation of the Descemet endothelial complex (DEC) is one of the causes of failure of Descemet membrane endothelial keratoplasty (DMEK). We evaluated a new marking technique to avoid such a misorientation. Method. A new marking technique of the DEC was evaluated in patients requiring primary DMEK. A Braille-“R”-letter was applied dot by dot onto the stromal surface of the DEC after lifting it by injecting an air-bubble into the interface between the endothelial surface of the partially stripped graft. The positioning of the graft was intraoperatively controlled by an orientation of the Braille-“R”-letter. Laboratory tests were conducted to test the impact of the marking technique on endothelial cell count. Results. We included prospectively 37 eyes of 30 patients. Four eyes were phakic and 33 pseudophakic. Five grafts (14%) presented an undifferentiated rolling tendency in the anterior chamber, and evaluation of their positioning was possible due to orientation of the mark alone. In case of an upside-down orientation, grafts were flipped immediately. A correct orientation of the graft was achieved in all cases at the end of the surgery. The endothelial cell loss due to the mark was estimated to be less than 0.3%. At 3- and 6-month follow-ups, the mean best-corrected visual acuity was 0.21 ± 0.15 and 0.15 ± 0.11 logMAR, respectively, and endothelial cell density was 1661 ± 349 and 1618 ± 396 cells/mm2, respectively. Only one patient (3%) needed re-bubbling. Conclusions. To rely on the natural rolling tendency of the graft alone does not assure its correct positioning in all cases. Creation of the mark with 4 dots punctuated on the air-lifted stromal side of the DEC is a simple and endothelial cell saving marking method to ensure correct orientation of the graft during DMEK.

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“…However, the time interval between DMEK and rebubbling seems to be of importance in the management of incomplete postoperative graft adherence. A series of 760 DMEK surgeries with 41 eyes requiring rebubbling (5.4%) investigating the clinical outcome after rebubbling for graft detachment after DMEK demonstrated that the visual outcomes may be similar to uncomplicated DMEK when rebubbling was performed within the first 6–8 weeks 15…”

Section: Discussionmentioning

confidence: 99%

Functional outcome of repeat Descemet membrane endothelial keratoplasty (DMEK) for corneal decompensation following graft failure after primary DMEK

Shajari¹,

Slavík-Lenčová²,

Kohnen³

et al. 2019

OPTH

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PurposeTo evaluate if repeat Descemet membrane endothelial keratoplasty (DMEK) is appropriate to achieve functional improvements in patients with corneal decompensation from secondary graft failure after primary DMEK.MethodsThis is a retrospective monocentric cohort study including 13 eyes of 13 patients with repeat DMEK for corneal decompensation following primary DMEK. Eyes with primary DMEK only and comparable preoperative corrected distance visual acuity (CDVA) served as control. Main outcome parameter was CDVA. Secondary outcome measures were central corneal thickness (CCT), endothelial cell density, and rebubbling rate (RR).ResultsThe average time interval (±SD) between primary and secondary DMEK was 12.5±6 months. Preoperative CDVA (logMAR) was 1.97±0.90 in the repeat DMEK group and 1.38±0.92 in the primary DMEK group. At 6 months, both groups showed significant improvement in visual acuity (repeat DMEK group, 0.49±0.35, P<0.01 and primary DMEK group, 0.40±0.36, P<0.01). CDVA did not differ significantly between both groups at all time points examined (1, 3, and 6 months postoperatively). Mean CCT values at 3 and 6 months postoperatively did not differ significantly between the two groups (P>0.05). The RR was 23% (n=3) in both groups.ConclusionRepeat DMEK is a useful therapeutic approach in the setting of corneal decompensation following primary DMEK. Functional results of repeat DMEK, visual acuity in particular, are comparable to patients with single DMEK only.

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Clinical Outcome of Rebubbling for Graft Detachment After Descemet Membrane Endothelial Keratoplasty

Cited by 56 publications

References 30 publications

<p>Outcome of Descemet membrane endothelial keratoplasty for graft failure after Descemet stripping automated endothelial keratoplasty</p>

<p>Outcome of Descemet membrane endothelial keratoplasty for graft failure after Descemet stripping automated endothelial keratoplasty</p>

How to Avoid an Upside-Down Orientation of the Graft during Descemet Membrane Endothelial Keratoplasty?

<p>Functional outcome of repeat Descemet membrane endothelial keratoplasty (DMEK) for corneal decompensation following graft failure after primary DMEK</p>

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