Recovery of Corneal Clarity After DMEK Followed by Rebubbling Versus Uneventful DMEK

Lazaridis, Apostolos; Fydanaki, Ourania; Giallouros, Eleftherios; Georgalas, Ilias; Kymionis, George D.; Sekundo, Walter; Droutsas, Konstantinos

doi:10.1097/ico.0000000000001554

Cited by 24 publications

(16 citation statements)

References 33 publications

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“…Our findings are congruous with a previous study which evaluated the effect of rebubbling on CD [23]. The authors did not find an increase of CD in the central cornea induced by rebubbling compared to a control group [23]. Furthermore, we did not observe structural abnormalities like Fig.…”

Section: Discussionsupporting

confidence: 80%

“…Since preoperative values were similar in the rebubbling and control group, the observed differences in the outcome in regard to visual acuity cannot be attributed to higher preoperative CD or subsequent morphologic changes in the rebubbling group. Our findings are congruous with a previous study which evaluated the effect of rebubbling on CD [23]. The authors did not find an increase of CD in the central cornea induced by rebubbling compared to a control group [23].…”

Section: Discussionsupporting

confidence: 70%

“…Postoperative ECL is a critical parameter while evaluating a patient for rebubbling due to a detached DMEK lamella since intraocular manipulation and or injection of SF6 gas is of potential harm to the sensitive corneal endothelium. The aforementioned study by Gerber-Hollbach detected a significant ECL (54% after 6 months follow-up) [11], which is congruous with findings reported by Lazaridis et al [23]. Feng and colleagues also demonstrated that repeat intracameral air injections resulted in a significant decrease in ECD [10].…”

Section: Discussionsupporting

confidence: 69%

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Influence of rebubbling on anterior segment parameters and refractive outcomes in eyes with DMEK for Fuchs endothelial dystrophy

Förster

Kohnen

Schmack

2021

Graefes Arch Clin Exp Ophthalmol

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Purpose To evaluate the potential impact of rebubbling on the anterior segment parameters and refractive outcomes in patients with graft detachment following uneventful DMEK for Fuchs endothelial dystrophy (FED). Methods Retrospective institutional cohort study of comparing 34 eyes of 31 patients with rebubbling for graft detachment following Descemet membrane endothelial keratoplasty (DMEK) to 33 eyes of 28 patients with uneventful DMEK. Main outcome parameters were various corneal parameters obtained by Scheimpflug imaging, refractive outcome, corrected distance visual acuity (CDVA), and endothelial cell density (ECD). Results Anterior and posterior corneal astigmatism, corneal densitometry, central corneal thickness, and anterior chamber depth and volume showed no significant differences. Preoperative distribution of astigmatism axis orientations showed a high proportion of anterior corneal with-the-rule astigmatism (71%) in eyes requiring rebubbling. Mean postoperative cylinder in the rebubbling group (1.21 ± 0.85 D) was significantly higher compared to the controls (p = 0.04), while differences in spherical equivalent (SE) were insignificant (p = 0.24). Postoperative CDVA was 0.11 ± 0.11 in the control group compared to 0.21 ± 0.17 in the rebubbling group (p = 0.03). Eyes with subsequent rebubbling demonstrated a significantly higher endothelial cell loss (56% versus 37%) (p < 0.001). Conclusion Apart from higher cylinder values, refractive outcome and corneal parameters assessed by Scheimpflug imaging were comparable in eyes with rebubbling and controls. However, a reduced visual acuity and an increased endothelial cell loss should be taken into consideration prior to rebubbling especially in eyes with circumscribed graft detachment.

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Section: Discussionsupporting

confidence: 80%

Section: Discussionsupporting

confidence: 70%

Section: Discussionsupporting

confidence: 69%

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Influence of rebubbling on anterior segment parameters and refractive outcomes in eyes with DMEK for Fuchs endothelial dystrophy

Förster

Kohnen

Schmack

2021

Graefes Arch Clin Exp Ophthalmol

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“…Previous studies show that, in particular, rebubbling frequency can be expected to be further reduced (Dapena et al 2011a;Schrittenlocher et al 2018). And, although a single rebubbling procedure does not appear to affect visual outcome (Lazaridis et al 2018), unnecessary endothelial cell loss should always be kept to a minimum.…”

Section: Discussionmentioning

confidence: 99%

“…And, although a single rebubbling procedure does not appear to affect visual outcome (Lazaridis et al. ), unnecessary endothelial cell loss should always be kept to a minimum.…”

Section: Discussionmentioning

confidence: 99%

The learning curve for Descemet membrane endothelial keratoplasty performed by two experienced corneal surgeons: a consecutive series of 40 cases

Wubbels

Remeijer

Engel

et al. 2019

Acta Ophthalmologica

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Purpose: To describe the learning curve for Descemet's membrane endothelial keratoplasty (DMEK) in the Rotterdam Eye Hospital and to evaluate safety and visual outcome. Methods: This was a single-centre prospective study of 40 consecutive patients with Fuchs' endothelial dystrophy who underwent a DMEK procedure in the Rotterdam Eye Hospital. The performance of two corneal surgeons, each conducting their first series of 20 procedures, was examined with the cumulative summation test for the learning curve (LC-CUSUM). The surgical procedure was considered unsuccessful when >30% of the graft was not attached at any time during the first 12 postoperative weeks and a mixture of SF 6 (20%) and air (80%) had to be injected in the anterior chamber (rebubbling) to reattach the graft. Also assessed were visual outcome, intraocular pressure and peri-and postoperative complications. Results: In total, nine rebubbling procedures were performed in seven eyes. Following repeated rebubbling, two eyes did not achieve a satisfactory result and secondary surgery was required to restore visual function. Complications were usually manageable. The last 13 DMEK procedures (33%) of this series did not require rebubbling. After 3 months, 86% of the eyes had reached a Snellen visual acuity of 0.5 or more. Conclusion: Together with the two surgeons' personal experience, the aggregate learning curve was considered to justify incorporation of Descemet membrane endothelial keratoplasty as a regular option of the standard of care for endothelial dysfunction in the Rotterdam Eye Hospital.Key words: cornea surgery -cumulative summation test for the learning curve -descemet membrane endothelial keratoplasty -learning curve Acta Ophthalmol. 2020: 98: 74-79

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Impact of difficult unfolding and attachment of the graft lamella on the long-term outcome after Descemet membrane endothelial keratoplasty

Gundlach

Spiller

Pilger

et al. 2020

Graefes Arch Clin Exp Ophthalmol

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Recovery of Corneal Clarity After DMEK Followed by Rebubbling Versus Uneventful DMEK

Abstract: A single rebubbling procedure does not increase the CD of the central cornea and but results in significantly higher ECL compared with uneventful DMEK with complete graft attachment.

Cited by 24 publications

References 33 publications

Influence of rebubbling on anterior segment parameters and refractive outcomes in eyes with DMEK for Fuchs endothelial dystrophy

Influence of rebubbling on anterior segment parameters and refractive outcomes in eyes with DMEK for Fuchs endothelial dystrophy

The learning curve for Descemet membrane endothelial keratoplasty performed by two experienced corneal surgeons: a consecutive series of 40 cases

Impact of difficult unfolding and attachment of the graft lamella on the long-term outcome after Descemet membrane endothelial keratoplasty

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