Comparison of 20% sulfur hexafluoride with air for intraocular tamponade in Descemet membrane endothelial keratoplasty (DMEK)

Abstract

Purpose: To compare the effect of 20% sulfur hexafluoride (SF 6 ) with that of air on graft detachment rates for intraocular tamponade in Descemet membrane endothelial keratoplasty (DMEK). Methods: Forty-two eyes of patients who underwent DMEK by a single surgeon (A.S.J.) at Wilmer Eye Institute between January 2012 and 2014 were identified; 21 received air for intraocular tamponade and the next consecutive 21 received SF 6 . The main outcome measure was the graft detachment rate; univariate and multivariate analyses were performed. Results: The graft detachment rate was 67% in the air group and 19% in the SF 6 group (p<0.05). No complete graft detachments occurred, and all partial detachments underwent intervention with injection of intraocular air. The percentages of eyes with 20/25 or better vision were not different between the groups (67% vs. 71%). Univariate analysis showed significantly higher detachment rates with air tamponade (OR, 8.50; p<0.005) and larger donor graft size (OR, 14.96; p<0.05). Multivariate analysis with gas but not graft size included showed that gas was an independent statistically significant predictor of outcome (OR, 6.65; p<0.05). When graft size was included as a covariate, gas was no longer a statistically significant predictor of detachment but maintained OR of 7.81 (p=0.063) similar to the results of univariate and multivariate analyses without graft size. Conclusion:In comparison with air, graft detachment rates for intraocular tamponade in DMEK were significantly reduced by 20% SF 6 .

Effects of Combined Cataract Surgery on Outcomes of Descemet's Membrane Endothelial Keratoplasty: A Systematic Review and Meta-Analysis

“…For instance, Dapena et al ( 52 ) demonstrated that the graft detachment rate of DMEK reduced from 20% in the first 45 cases to 4.4% in the 91–135 cases. In addition, the use of 20% SF 6 for intraocular tamponade in DMEK has been reported to reduce the rate of partial graft detachment significantly when compared with air ( 69 ).…”

Descemet membrane endothelial keratoplasty: Update on preoperative considerations, surgical techniques, and outcomes

“… Graft detachment:[ 10 11 12 19 35 36 37 39 40 62 63 64 65 66 67 68 69 70 71 72 73 74 75 76 77 78 79 80 81 82 83 84 ] Raised IOP:[ 10 19 62 66 85 86 87 88 89 90 91 92 93 94 ] Graft rejection:[ 92 93 94 95 96 97 98 99 100 101 102 103 104 105 106 107 108 109 110 111 112 ] Graft failure:[ 10 84 109 113 114 115 116 ] Pupillary abnormality:[ 117 ...…”

“…Graft detachment:[ 10 11 12 19 35 36 37 39 40 62 63 64 65 66 67 68 69 70 71 72 73 74 75 76 77 78 79 80 81 82 83 84 ]…”

Descemetorhexis Without Endothelial Keratoplasty in Fuchs Endothelial Corneal Dystrophy: A Systematic Review and Meta-Analysis

“…[63][64][65][66][67] However, EK requires a long learning curve [68][69][70] and high rebubbling rate (particularly for DMEK), 71 which limit its large diffusion. [72][73][74][75][76] Considering our systematic review and meta-analysis, we suggest following a treatment algorithm to treat the early stages of FECD. In cases of failing central endothelium with central corneal edema, DWEK could be considered, with the stripped zone limited to 4 mm.…”