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Influences on rebubble rate in Descemet's membrane endothelial keratoplasty

Authors Mechels KB, Greenwood MD, Sudhagoni RG, Berdahl JP

Received 25 July 2017

Accepted for publication 20 October 2017

Published 5 December 2017 Volume 2017:11 Pages 2139—2144


Checked for plagiarism Yes

Review by Single anonymous peer review

Peer reviewer comments 2

Editor who approved publication: Dr Scott Fraser

Keegan B Mechels,1 Michael D Greenwood,2 Ramu G Sudhagoni,3 John P Berdahl2

1Sanford School of Medicine, University of South Dakota, Vermillion, SD, 2Vance Thompson Vision, Sioux Falls, SD, 3School of Health Sciences, University of South Dakota, Vermillion, SD, USA

Purpose: Descemet’s membrane endothelial keratoplasty (DMEK) is a minimally invasive partial corneal transplant procedure used in patients with failing endothelial membranes. This study aims to identify those factors which influence the need for a rebubble of the corneal graft.
Methods: A total of 94 eyes that received DMEK between March 2014 and January 2016 at Vance Thompson Vision were used in the study. Demographic and graft data were collected from the patients and donors, and perioperative statistics of the procedures. A logistical regression was used to compare eyes that did and did not require a rebubble.
Results: Among those characteristics that were included (patient age/sex, donor age/sex, death to processing time, donation to surgery time, death to procurement time, specular cell count density, burping procedure, postoperative day 1 intraocular pressure [IOP], and postoperative week 1 IOP, concurrent phacoemulsification, and how well the Descemet graft was centered), only a lower specular cell count density of the corneal graft, and a graft that was not well-centered correlated with needing a rebubble due to partial graft detachment (p=0.021) and (p=0.023), respectively.
Conclusion: An increased specular cell count density may allow for better placement of the corneal graft by allowing for better unfolding in DMEK procedures. A well-centered graft may decrease postoperative complications by increasing adherence. Additionally, postoperative management of IOP may not affect the rebubble rate, and therefore should be left to the discretion of the provider to determine whether it is necessary.

Keywords: descemet, rebubble, keratoplasty, DMEK

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