The Cologne rebubbling study: a reappraisal of 624 rebubblings after Descemet membrane endothelial keratoplasty

Abstract

Background/AimsTo analyse graft detachments prior to rebubbling, the influence of rebubbling on the postoperative outcome after Descemet membrane endothelial keratoplasty (DMEK) and the need for rebubbling on the contralateral eye.MethodsIn this retrospective cohort study, out of 1541 DMEKs, optical coherence tomography scans and clinical records of 499 eyes undergoing rebubbling after DMEK at the University Hospital of Cologne, Cologne, Germany, were examined. Main Outcome measures were (a) number, localisation and size of graft detachments; (b) influence of rebubbling/s on postoperative outcome after 12 months; and (c) rebubbling risk of the contralateral eye after DMEK.ResultsMean number of detachment areas was 2.02±0.9. Mean lateral diameter of all detachments was 4534.76±1920.83 μm. Mean axial diameter was 382.53±282.02 μm. Detachments were equally distributed over all regions of the cornea. Best spectacle corrected visual acuity ( BSCVA) after 12 months was 0.197±0.23 logarithm of the minimum angle of resolution, endothelial cell density (ECD) was 1575.21±397.71 cells/mm2 and mean central corneal thickness (CCT) was 566.37±68.11 μm. BSCVA, CCT, ECD or endothelial cell loss of all rebubbled patients were not influenced by the number of rebubblings or the time between DMEK and rebubbling. Of the rebubbled patients, which received a DMEK subsequently on the other eye, 193 (58.8%) also received a rebubbling, which was significantly higher, when compared to the overall rebubbling rate of 32.3% (p=0.000).ConclusionsThe overall number of rebubblings has no influence on the postoperative outcome after DMEK, if a rebubbling becomes necessary. Patients who received a rebubbling on one eye have an elevated risk for a rebubbling on the fellow eye.

Graft Detachment after Descemet Membrane Endothelial Keratoplasty with and without Cataract Surgery

“…In contrast to previous manual analyses of detachment pattern, which reported a diffuse overall detachment with a trend towards the inferior-nasal cornea, 6,29 our automated, in-depth analysis suggested a directional pattern of graft detachment (Figure 2). While most grafts were not completely attached at the inferior cornea in the first days after surgery, two weeks later, most grafts were completely attached at the site of the surgical iridectomy.…”

A machine learning approach to explore predictors of graft detachment following posterior lamellar keratoplasty: a nationwide registry study

“…This discrepancy may be explained in part by the recent transition of surgeons to using SF6 gas together with the concomitant transition to performing DMEK (with a subsequent increased risk of detachment in their learning curve). Nevertheless, we believe that the previously reported putative benefits associated with using SF6 gas might have been overestimated relative to all other factors and is exemplified by continued reports of relatively high rates of graft detachment 5 , 6 , 12 , 40 , 44 , 45 . After posterior lamellar keratoplasties, patients are instructed to remain in the supine position in order to maximize the beneficial effects of AC tamponade, and the length of time in this position can affect the risk of graft detachment.…”

Identification of the preoperative and perioperative factors that predict postoperative endothelial cell density after Descemet membrane endothelial keratoplasty: A retrospective cohort study

“…This may reflect in part the liberal use of rebubbling in our center. Other studies have also failed to detect a relationship between rebubbling and ECL [ 47 , 48 , 69 ].…”