Rebubbling Techniques for Graft Detachment After Descemet Membrane Endothelial Keratoplasty

López, Ester Fernández; Baydoun, Lamis; Gerber-Hollbach, Nadine; Dapena, Isabel; Liarakos, Vasilios S.; Ham, Lisanne; Melles, Gerrit R.J.

doi:10.1097/ico.0000000000000829

Cited by 45 publications

(14 citation statements)

References 27 publications

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“…The rationale for this approach is based both on the difficulty of treating at a later stage patients coming from long distances, including foreign countries, like most of those referred to our Institution, and on an attempt at maximizing as early as possible the amount of attached and therefore functioning endothelial cells. In fact, as detached portions of DMEK grafts become fibrotic with time and cannot be reattached, 19 it is conceivable that this loss of functioning donor tissue, although limited in extension, may affect the long-term graft survival. Nevertheless, independently of these considerations, the focus of our study was to identify risk factors for detachment and not to be able to predict the appropriate treatment of this complication.…”

Section: Discussionmentioning

confidence: 99%

Factors Associated With Early Graft Detachment in Primary Descemet Membrane Endothelial Keratoplasty

Leon

Parekh

Nahum

et al. 2018

American Journal of Ophthalmology

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Section: Discussionmentioning

confidence: 99%

Factors Associated With Early Graft Detachment in Primary Descemet Membrane Endothelial Keratoplasty

Leon

Parekh

Nahum

et al. 2018

American Journal of Ophthalmology

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“…Rebubbling rates vary but are significantly higher in DMEK cases than in DSAEK occurring in 5e10% of DMEK procedures, depending on technique and surgical skill. 30,40,89,114 Detachment rates can reach up to 35% during the surgical learning curve. 94 Forty-one cases have been reported where a complicated EK underwent unexpected clinical improvement, and these are summarized in Table 1.…”

Section: Resultsmentioning

confidence: 99%

A review of the evidence for in vivo corneal endothelial regeneration

Bogerd

Dhubhghaill

Koppen

et al. 2018

Survey of Ophthalmology

108

104

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Human corneal endothelium has long been thought to be a nonmitotic cell layer with no endogenous reparative potential. Pathologies that damage endothelial function result in corneal decompensation and, if untreated, blindness. The mainstay of treatment involves partial or complete corneal replacement, amounting to 40% of all corneal transplants performed worldwide. We summarize the case reports describing complications postoperatively in the form of (sub)total graft detachment and those resulting in postoperative bare stroma. Complications during cataract and glaucoma surgeries leading to an uncovered posterior cornea are also included. We discuss the newer treatment strategies that are alternatives for current Descemet membrane endothelial keratoplasty and Descemet stripping automated endothelial keratoplasty, including partial grafts and stripping of the diseased cell layer. In more than half of the cases reviewed, corneal transparency returned despite incomplete or no corneal endothelial cell transplantation. We question the existing paradigm concerning corneal endothelial wound healing in vivo. The data support further clinical study to determine the safety of simple descemethorexis in central endothelial pathologies, such as Fuchs endothelial corneal dystrophy, where presence of healthy peripheral cells may allow successful corneal recompensation without the need for donor cells.

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“…Fernandez Lopez described a higher rate of graft detachment, increased graft stiffness and/or fibrosis when re-bubbling was performed several weeks after initial DMEK [10]. In our patient, the reorientation of the upside-down graft 4 weeks after implantation was not affected by any complications.…”

Section: Discussionmentioning

confidence: 52%

Favourable outcome after late reorientation of an upside-down Descemet Membrane Endothelial Keratoplasty (DMEK) graft: a case report

Mariacher

Boden

et al. 2019

BMC Ophthalmol

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Background Clinical outcome after successful reorientation of an upside-down implanted DMEK (Descemet Membrane Endothelial Keratoplasty) graft 4 weeks after initial transplantation. Case presentation A 71-year-old woman presented with Fuchs’ endothelial corneal dystrophy for DMEK. After initial DMEK the donor graft was fully attached and well centred during intracameral gas filling. When the gas bubble was fully resorbed the graft started to detach. Therefore, two intracameral gas injections were consecutively performed. During the second re-bubbling, an upside-down orientation was observed and so the graft was flipped, centred, re-attached and finally stabilized by an intracameral gas bubble. Three weeks after reorientation slit lamp examinations showed a well centred and attached graft, endothelial cells that started functioning and a patient’s visual acuity of 20/40. Visual acuity increased to a 20/32 vision in the observed eye three months later and further improved to 20/20 6 months after reorientation and stayed stable between 20/32 and 20/20 during the remaining 15 months of follow-up, with a clear and well-attached graft. Conclusion Reorientation of an upside down DMEK graft was successful even 4 weeks after initial DMEK. Visual recovery and endothelial cell count increase were stepwise noticed during the first 6 months and 15 months after reorientation, respectively. Finally a favourable outcome with 20/32 to 20/20 vision at least 6 months after graft reorientation was achieved. Therefore, restoring full graft function could last several weeks or even months following (late) reorientation of an upside-down DMEK graft.

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Rebubbling Techniques for Graft Detachment After Descemet Membrane Endothelial Keratoplasty

Cited by 45 publications

References 27 publications

Factors Associated With Early Graft Detachment in Primary Descemet Membrane Endothelial Keratoplasty

Factors Associated With Early Graft Detachment in Primary Descemet Membrane Endothelial Keratoplasty

A review of the evidence for in vivo corneal endothelial regeneration

Favourable outcome after late reorientation of an upside-down Descemet Membrane Endothelial Keratoplasty (DMEK) graft: a case report

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