Graft Adhesion in Descemet Membrane Endothelial Keratoplasty Dependent on Size of Removal of Host’s Descemet Membrane

Abstract

that reviewed the medical records of 200 consecutive patients undergoing DMEK. Fifty-three eyes of 51 patients undergoing DMEK for Fuchs endothelial dystrophy fulfilling the inclusion criteria were enrolled in this study. Based on intraoperative drawings, postoperative slitlamp examination, and photographs, eyes were divided into 2 groups. The diameter of the descemetorhexis was approximately 10 mm in group A (30 eyes), resulting in a peripheral 1-mm zone of denuded stroma between the graft and the host's Descemet membrane, and approximately 6 mm in group B (23 eyes), resulting in a peripheral 1-mm zone of overlapping between the graft and the host's Descemet membrane. MAIN OUTCOMES AND MEASURESGraft detachment rate, extent of graft detachment (in clock hours of graft's circumference), and rebubbling rate.RESULTS Four days after DMEK, the graft detachment rate was 33.3% (10 of 30) in group A and 78.3% (18 of 23) in group B (P = .002). The mean (SD) extent of graft detachment was 0.6 (0.9) and 2.8 (2.5) clock hours in groups A and B, respectively (P < .001), 4 days after surgery. The rebubbling rate was 6.7% (2 of 30) and 30.4% (7 of 23) for groups A and B, respectively (P = .03). CONCLUSIONS AND RELEVANCEA larger descemetorhexis in DMEK is correlated with better graft adhesion and lower rebubbling rates. Therefore, patients with a larger descemetorhexis require less intensive follow-up.

Descemet Membrane Endothelial Keratoplasty: Update on Endothelial Transplantation Techniques

“…In any case, we thought that this difference in size would allow a better attachment rate, as has also been recently suggested by the Kruse group [85] .…”

Anterior Chamber Air Bubble to Achieve Graft Attachment After DMEK

“…In contrast, an 80% air bubble will cover 100% of the graft in a supine and approximately 90% in an upright position. According to Tourtas et al, 23 the higher frequency of graft detachments in the inferior portion of the cornea might be attributed to this part being less in contact with the shrinking air bubble in upright positions of the patients.…”

“…In another study, we recently found that the size of the descemetorhexis also has an influence on graft adherence. 23 Other known significant factors include preexisting graft damage, 27 intraoperative trauma, 27 and, as mentioned before, surgeon experience. 28,29 According to our clinical experience, the amount of intraoperative rolling and the ease of graft insertion and its fragility all depend on donor age.…”

Clinical Outcomes of Descemet Membrane Endothelial Keratoplasty Using Eye Bank–Prepared Tissues

“…14,24-26 These techniques include elimination of viscoelastic, use of SF6, and oversizing the descemetorrhexis of the recipients. 3,7,26,27 Often, a combination of surgical techniques to efficiently unfold the DM scroll is necessary, particularly in eyes with altered anatomy, such as those that have undergone previous glaucoma surgeries.…”