Pia Leon1, Mohit Parekh2, Yoav Nahum3, Michael Mimouni4, Giuseppe Giannaccare5, Laura Sapigni6, Alessandro Ruzza7, Massimo Busin8. 1. Ospedale "SS. Giovanni e Paolo," Department of Ophthalmology, Venice, Italy; Ospedali Privati Forlì, Department of Ophthalmology, Forlì, Italy; Istituto internazionale per la Ricerca e Formazione in Oftalmologia (IRFO), Forlì, Italy. 2. International Center for Ocular Physiopathology (ICOP), The Veneto Eye Bank Foundation, Zelarino, Venice, Italy; Department of Molecular Medicine, School of Biomedicine, University of Padova, Padova, Italy. 3. Rabin Medical Center, Department of Ophthalmology, Petah Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel. 4. Department of Ophthalmology, Rambam Health Care Campus, Haifa, Israel. 5. Ospedali Privati Forlì, Department of Ophthalmology, Forlì, Italy; Istituto internazionale per la Ricerca e Formazione in Oftalmologia (IRFO), Forlì, Italy; Department of Ophthalmology, S.Orsola-Malpighi Hospital, DIMES, University of Bologna, Bologna, Italy. 6. Ospedali Privati Forlì, Department of Ophthalmology, Forlì, Italy; Istituto internazionale per la Ricerca e Formazione in Oftalmologia (IRFO), Forlì, Italy. 7. International Center for Ocular Physiopathology (ICOP), The Veneto Eye Bank Foundation, Zelarino, Venice, Italy. 8. Ospedali Privati Forlì, Department of Ophthalmology, Forlì, Italy; Istituto internazionale per la Ricerca e Formazione in Oftalmologia (IRFO), Forlì, Italy; Department of Morphology, Surgery and Experimental Medicine, University of Ferrara, Ferrara, Italy. Electronic address: mbusin@yahoo.com.
Abstract
PURPOSE: To evaluate the risk factors for early graft detachment in Descemet membrane endothelial keratoplasty (DMEK). DESIGN: Case-control study. METHODS: Participants: A total of 173 donor corneas and 173 eyes of the patients following DMEK or DMEK in combination with phacoemulsification and intraocular lens implantation were included. INTERVENTION: Pre-stripped DMEK grafts were transplanted using pull-through technique. At the end of surgery, the anterior chamber was filled with air, which was removed 3 hours later only if pupillary block was suspected. Rebubbling was performed in all cases with graft detachment, independently of its extension, as documented by means of anterior segment optical coherence tomography. The donor characteristics were collected from the eye bank database and matched with the recipient database. MAIN OUTCOME MEASURES: Donor and recipient characteristics affecting graft detachment using univariate and multivariate analysis. RESULTS: The combination of DMEK with cataract removal and IOL implantation (odds ratio [OR] = 5.31, 95% confidence interval [CI] 2.03-13.86, P < .002) and air fill of ≤75% of anterior chamber height at 2-3 hours postoperatively (OR = 2.66, 95% CI 1.12-6.34, P = .027) were found to be independent risk factors for postoperative graft detachment. CONCLUSIONS: Cataract removal at the time of DMEK is a risk factor for early graft detachment and therefore sequential surgery may be preferred over combined surgery in an attempt at minimizing rebubbling. Air level in the anterior chamber should be monitored and maintained above 75% in the early hours following surgery.
PURPOSE: To evaluate the risk factors for early graft detachment in Descemet membrane endothelial keratoplasty (DMEK). DESIGN: Case-control study. METHODS:Participants: A total of 173 donor corneas and 173 eyes of the patients following DMEK or DMEK in combination with phacoemulsification and intraocular lens implantation were included. INTERVENTION: Pre-stripped DMEK grafts were transplanted using pull-through technique. At the end of surgery, the anterior chamber was filled with air, which was removed 3 hours later only if pupillary block was suspected. Rebubbling was performed in all cases with graft detachment, independently of its extension, as documented by means of anterior segment optical coherence tomography. The donor characteristics were collected from the eye bank database and matched with the recipient database. MAIN OUTCOME MEASURES: Donor and recipient characteristics affecting graft detachment using univariate and multivariate analysis. RESULTS: The combination of DMEK with cataract removal and IOL implantation (odds ratio [OR] = 5.31, 95% confidence interval [CI] 2.03-13.86, P < .002) and air fill of ≤75% of anterior chamber height at 2-3 hours postoperatively (OR = 2.66, 95% CI 1.12-6.34, P = .027) were found to be independent risk factors for postoperative graft detachment. CONCLUSIONS:Cataract removal at the time of DMEK is a risk factor for early graft detachment and therefore sequential surgery may be preferred over combined surgery in an attempt at minimizing rebubbling. Air level in the anterior chamber should be monitored and maintained above 75% in the early hours following surgery.
Authors: Kyeong Hwan Kim; Marius A Tijunelis; Yunshu Zhou; David C Musch; Christopher T Hood; Bradford L Tannen; Shahzad I Mian Journal: Cornea Date: 2020-10 Impact factor: 2.651