Impact of Re-bubbling after Descemet Membrane Endothelial Keratoplasty on Long-term Results

Gundlach, Enken; Pilger, Daniel; Dietrich-Ntoukas, Tina; Joussen, Antonia M.; Torun, Necip; Maier, Anna-Karina B.

doi:10.1080/02713683.2020.1842459

Cited by 19 publications

(15 citation statements)

References 34 publications

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“…The preoperative glaucoma medication with carbonic anhydrase inhibitors, glaucoma classification, preoperative IOP, post-DMEK glaucoma, or re-bubbling did not influence the risk for graft failure. The impact of re-bubbling on the endothelial cell density and graft failure rate had been analyzed before and different studies showed an increased endothelial cell loss after re-bubbling but no reduced graft survival [12,[35][36][37] as shown by our data. The re-bubbling rate itself (22.7%) was not higher compared to studies of centers using the same re-bubbling strategy [19].…”

Section: Graft Rejection and Graft Failuresupporting

confidence: 71%

Graft failure rate and complications after Descemet membrane endothelial keratoplasty in eyes with pre-existing glaucoma

Maier

Pilger

Gundlach

et al. 2022

Graefes Arch Clin Exp Ophthalmol

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Purpose To evaluate the outcome of Descemet Membrane Endothelial Keratoplasty (DMEK) in eyes with pre-existing glaucoma. Design In this retrospective, observational case series we included data of 150 consecutive DMEKs in eyes with pre-existing glaucoma of 150 patients after excluding data of the second treated eye of each patient and of re-DMEKs during follow-up. Cumulative incidences of IOP elevation (IOP > 21 mmHg or ≥ 10 mmHg increase in IOP from preoperative value), post-DMEK glaucoma (need of an additional intervention due to worsening of the IOP), graft rejection, and graft failure rate were analyzed using Kaplan–Meier survival analysis. COX regression analysis was used to evaluate independent risk factors. Results The 36-month cumulative incidence of IOP elevation was 53.5% [95 CI 43.5–63.5%] and of post-DMEK glaucoma 36.3% [95 CI 26.3–46.3%]. Graft rejection occurred with a 36-month cumulative incidence of 9.2% [CI 95% 2.3–16.1]. None of the analyzed risk factors increased the risk for the development of graft rejection. The 36-month cumulative incidence of graft failure was 16.6% [CI 95% 8.4–24.8]. Independent risk factors for graft failure were the indication for DMEK “status after graft failure” (n = 16) compared to Fuchs’ dystrophy (n = 74) (p = 0.045, HR 8.511 [CI 95% 1.054–68.756]) and pre-existing filtrating surgery via glaucoma drainage device (GDD) (n = 10) compared to no surgery/iridectomy (n = 109) (p = 0.014, HR 6.273 [CI 95% 1.456–27.031]). Conclusion The risks of postoperative complications (IOP elevation, post-DMEK glaucoma, graft rejection, and graft failure) in patients with pre-existing glaucoma are high. In particular, pre-existing filtrating surgery via GDD implantation—but not trabeculectomy—and DMEK after graft failure increase the risk of graft failure.

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Section: Graft Rejection and Graft Failuresupporting

confidence: 71%

Graft failure rate and complications after Descemet membrane endothelial keratoplasty in eyes with pre-existing glaucoma

Maier

Pilger

Gundlach

et al. 2022

Graefes Arch Clin Exp Ophthalmol

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“… NS NS NS < 0.0001 Besek 2022 [ 12 ] 150 mixed 7 y Multi. 0.009 NS NS NS Gund 2021 [ 13 ] 463 mixed 12 mo Multi. NS c Agha 2021 [ 15 ] 33 FECD 9 mo C-C 0.03 Romano 2022 [ 16 ] 91 mixed 12 mo Univ.…”

Section: Discussionunclassified

“…Four of nine studies on rebubbling were multivariate analyses that reported different outcomes despite being conducted similarly: in two, mild and/or severe detachment predicted worse final VA [ 11 , 20 ] whereas in another two, neither mild/severe detachment nor rebubbling predicted VA [ 12 , 13 ]. Why these studies differed is unclear.…”

Section: Discussionmentioning

confidence: 99%

Ability of routinely collected clinical factors to predict good visual results after primary Descemet membrane endothelial keratoplasty: a cohort study

et al. 2022

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Background A comprehensive analysis of routinely collected pre/perioperative demographic/clinical factors that could predict final visual acuity after primary Descemet membrane endothelial keratoplasty (DMEK) has not been conducted previously. Methods A retrospective monocenter cohort study was performed with consecutive patients with Fuchs endothelial corneal dystrophy (FECD) who underwent DMEK or triple-DMEK (DMEK combined with cataract surgery) in 2016–2020 in a French tertiary-care hospital. DMEK-only patients were pseudophakic. Patients were followed for 12 months. Surgery was considered successful when 12-month best-corrected visual acuity (BCVA) was ≤0.1 logMAR (≥0.8). Exploratory multivariate analysis was conducted with the following routinely collected variables to determine their ability to predict 12-month BCVA: patient age and sex; graft donor age; triple DMEK; preoperative values of BCVA, endothelial cell density (ECD), central corneal thickness (CCT), and mean anterior keratometry; and rebubbling. Results Of 100 eyes (100 patients; mean age, 72 years; 61% female), 81 achieved a 12-month BCVA of ≤0.1 logMAR. Logistic regression analysis showed that older age was a significant prognosticator for 12-month BCVA > 0.1 logMAR (Odds Ratio = 0.914, 95% confidence intervals = 0.846–0.987; p = 0.02). Conclusions An older age associated with worse visual acuity outcomes after DMEK. This was confirmed by our analysis of the literature and supports the notion that DMEK should be conducted without delay once symptoms appear. Patient sex, donor age, triple-DMEK, and anterior keratometry also did not predict final BCVA in the literature. Preoperative CCT, ECD, and BCVA, and rebubbling occasionally appear in the literature as BCVA predictors, possibly reflecting an underlying ECD-BCVA axis.

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“…It is known that each re-bubbling has a negative impact on ECD. 12 Therefore, it would have been difficult to estimate the effect of suturing independently on the ECD once the patient underwent two re-bubbling procedures prior to suturing. Further reports and studies with a larger sample size are required to fully assess the long- term safety and efficacy of this technique.…”

Section: Discussionmentioning

confidence: 99%

Descemet membrane suturing to manage recurrent graft detachment in a patient with Descemet membrane endothelial keratoplasty on failed penetrating keratoplasty

2021

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A 65-year-old patient with history of keratoconus, mild cataract and penetrating keratoplasty over 30 years ago developed corneal oedema subsequent of graft failure with best corrected visual acuity (BCVA) of counting fingers. He underwent a successful cataract surgery combined with a 7.25 mm Descemet’s Membrane Endothelial Keratoplasty (DMEK) with Sodium Hexafluoride (SF6) gas. His cornea remained oedematous inferiorly at 4 weeks, despite two subsequent re-bubbling due to persistent DMEK detachment inferiorly. This was managed by three radial full thickness 10-0 nylon sutures placed in the inferior cornea along with intracameral injection of air. Following this, his anterior segment ocular coherence tomography (OCT) confirmed complete attachment of the graft, and the sutures were removed 4 weeks later. Unaided visual acuity was 20/63 and BCVA was 20/32 after 8 months. DMEK suturing can be helpful in persistent DMEK detachments, which is refractory to repeated re-bubbling due to uneven posterior surface of previous PK.

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Impact of Re-bubbling after Descemet Membrane Endothelial Keratoplasty on Long-term Results

Cited by 19 publications

References 34 publications

Graft failure rate and complications after Descemet membrane endothelial keratoplasty in eyes with pre-existing glaucoma

Graft failure rate and complications after Descemet membrane endothelial keratoplasty in eyes with pre-existing glaucoma

Ability of routinely collected clinical factors to predict good visual results after primary Descemet membrane endothelial keratoplasty: a cohort study

Descemet membrane suturing to manage recurrent graft detachment in a patient with Descemet membrane endothelial keratoplasty on failed penetrating keratoplasty

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