Sulfur Hexafluoride 20% Versus Air 100% for Anterior Chamber Tamponade in DMEK: A Meta-Analysis

Marques, Raquel; Guerra, Paulo Silva; Sousa, David Cordeiro; Ferreira, Nuno Pinto; Quintas, Ana; Rodrigues, Walter

doi:10.1097/ico.0000000000001581

Cited by 40 publications

(18 citation statements)

References 49 publications

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“…In our study 34.6% of eyes received a rebubbling because of a partial graft detachment. This matches described rebubbling rates of 19.1–66.7% after air tamponade [ 32 ]. In a meta-analysis on AC tamponades in DMEK surgery, Marques et al reported a significantly lower rebubbling rate after 20% SF 6 tamponade (15.2 vs. 49.0% after air), corresponding to a rebubbling risk reduction by 58.0% [ 32 ].…”

Section: Discussionsupporting

confidence: 87%

“…This matches described rebubbling rates of 19.1–66.7% after air tamponade [ 32 ]. In a meta-analysis on AC tamponades in DMEK surgery, Marques et al reported a significantly lower rebubbling rate after 20% SF 6 tamponade (15.2 vs. 49.0% after air), corresponding to a rebubbling risk reduction by 58.0% [ 32 ]. These findings led us to adopt 20% SF 6 tamponade for all DMEK surgeries from 2019 onwards.…”

Section: Discussionsupporting

confidence: 87%

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Effects of uncomplicated Descemet membrane endothelial keratoplasty on the central retinal thickness

Lohmann

Baumgarten

Plange

et al. 2021

Graefes Arch Clin Exp Ophthalmol

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Purpose To determine retinal thickness (RT) changes and the incidence of macular edema after uncomplicated Descemet membrane endothelial keratoplasty (DMEK-ME) in patients without ME risk factors. Methods In this retrospective study, 107 pseudophakic eyes of 74 patients with Fuchs endothelial dystrophy (FED) (79.4%) or bullous keratopathy (BK) (20.6%) underwent DMEK surgery between 2016 and 2019 at the Department of Ophthalmology, RWTH Aachen University. Patients with intra- or postoperative complications as well as pre-existing risk factors for ME were excluded. Macular spectral-domain optical coherence tomography (SD-OCT) and best spectacle-corrected visual acuity (BSCVA) measurements were performed before, 1 week, 1 month, and 6 months after surgery. Retinal thickness (RT) was analyzed in the central foveal 1 mm (CSF), parafoveal 3 mm and 6 mm subfield. Results Eight eyes (7.5%) developed DMEK-ME 1 month after surgery. Six DMEK-ME eyes (75%) were rebubbled, compared with 31.3% (31 of 99; P = 0.02) of the non DMEK-ME eyes. DMEK-ME eyes had a significantly thicker CSF 1 month after surgery (432.0 ± 97.6 μm) compared with non-DMEK-ME eyes (283.7 ± 22.2 μm; P = 0.01). The other subfields and time points showed no significant RT changes. DMEK-ME significantly impaired BSCVA (0.38 ± 0.92 logMAR) only 1 month after surgery in comparison to the non DMEK-ME eyes (0.23 ± 0.87 logMAR, P = 0.015). Conclusion Excluding systemic and surgery-related risk factors, rebubbling increases the risk of DMEK-ME. Performing a CSF scan 1 month after surgery, particularly in rebubbled eyes, efficiently detects DMEK-ME and allows the prompt initiation of treatment, e.g., topical corticosteroid and non-steroidal (NSAID) eye drops.

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Section: Discussionsupporting

confidence: 87%

Section: Discussionsupporting

confidence: 87%

Effects of uncomplicated Descemet membrane endothelial keratoplasty on the central retinal thickness

Lohmann

Baumgarten

Plange

et al. 2021

Graefes Arch Clin Exp Ophthalmol

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“…Nevertheless, postoperative lamellar detachment is still a major issue in DMEK often requiring intracameral air and/or gas injection (rebubbling) [8]. Among the available tamponades, 20% sulfur hexafluoride (SF6) seems to be most effective without obvious side effects on the corneal endothelium [9]. However, there are still concerns about a potentially induced endothelial cell loss and impaired visual outcome secondary to rebubbling [10,11].…”

Section: Key Messagesmentioning

confidence: 99%

Influence of rebubbling on anterior segment parameters and refractive outcomes in eyes with DMEK for Fuchs endothelial dystrophy

Förster

Kohnen

Schmack

2021

Graefes Arch Clin Exp Ophthalmol

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Purpose To evaluate the potential impact of rebubbling on the anterior segment parameters and refractive outcomes in patients with graft detachment following uneventful DMEK for Fuchs endothelial dystrophy (FED). Methods Retrospective institutional cohort study of comparing 34 eyes of 31 patients with rebubbling for graft detachment following Descemet membrane endothelial keratoplasty (DMEK) to 33 eyes of 28 patients with uneventful DMEK. Main outcome parameters were various corneal parameters obtained by Scheimpflug imaging, refractive outcome, corrected distance visual acuity (CDVA), and endothelial cell density (ECD). Results Anterior and posterior corneal astigmatism, corneal densitometry, central corneal thickness, and anterior chamber depth and volume showed no significant differences. Preoperative distribution of astigmatism axis orientations showed a high proportion of anterior corneal with-the-rule astigmatism (71%) in eyes requiring rebubbling. Mean postoperative cylinder in the rebubbling group (1.21 ± 0.85 D) was significantly higher compared to the controls (p = 0.04), while differences in spherical equivalent (SE) were insignificant (p = 0.24). Postoperative CDVA was 0.11 ± 0.11 in the control group compared to 0.21 ± 0.17 in the rebubbling group (p = 0.03). Eyes with subsequent rebubbling demonstrated a significantly higher endothelial cell loss (56% versus 37%) (p < 0.001). Conclusion Apart from higher cylinder values, refractive outcome and corneal parameters assessed by Scheimpflug imaging were comparable in eyes with rebubbling and controls. However, a reduced visual acuity and an increased endothelial cell loss should be taken into consideration prior to rebubbling especially in eyes with circumscribed graft detachment.

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“…The results so far have been shown for the case of air fill. However, several reports have advocated for the use of SF6 due to the suggestion of improved outcomes 20,21. We compared air and SF6 in a numeric investigation for the case of the phakic model using SF6 (ACD = 3 mm).…”

Section: Resultsmentioning

confidence: 99%

Gas-Graft Coverage After DMEK: A Clinically Validated Numeric Study

Pralits

Alberti

Cabreizo

2019

Trans. Vis. Sci. Tech.

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PurposeWe investigate the influence of positioning, gas fill, and anterior chamber size on bubble configuration and graft coverage after Descemet's membrane endothelial keratoplasty (DMEK).MethodsWe use a mathematical model to study the bubble shape and graft coverage in eyes of varying anterior chamber depths (ACD). The governing equations are solved numericly using the open source software OpenFOAM. Numeric results are validated clinically so that clinical gas fill measures can be correlated with numeric results providing gas-graft coverage information otherwise clinically inaccessible.ResultsIn a phakic eye (ACD = 2.65 mm) with a gas fill of 35%, graft contact ranged from 35% to 38% depending on positioning and increased to 85% to 92% with a 70% fill. In contrast, positioning of a pseudophakic eye (ACD = 4.35) with a gas fill of 35% results in graft contact ranging from 8% to 52%, increasing to 63% to 94% with a 70% fill. The mathematical model demonstrates negligible differences between air and SF6 results and interestingly, a very thin central patch of aqueous humor within the gas bubble is found in some cases.ConclusionsGraft coverage in phakic eyes (ACD ≤ 3 mm) is dominated by the gas fill and less sensitive to patient positioning. In pseudophakic eyes with larger values of ACD, the graft coverage depends on gas fill and patient positioning with positioning even more important as ACD increases.Translational RelevanceAnterior chamber depth markedly influences the role of patient positioning in gas-filled eyes after DMEK due to the interplay between anterior chamber anatomy and gas bubble morphology.

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Sulfur Hexafluoride 20% Versus Air 100% for Anterior Chamber Tamponade in DMEK: A Meta-Analysis

Abstract: In DMEK, 20% SF6 tamponade and longer postoperative time supine were associated with 58% fewer rebubbling procedures, and an ECL not statistically different from using 100% air.

Cited by 40 publications

References 49 publications

Effects of uncomplicated Descemet membrane endothelial keratoplasty on the central retinal thickness

Effects of uncomplicated Descemet membrane endothelial keratoplasty on the central retinal thickness

Influence of rebubbling on anterior segment parameters and refractive outcomes in eyes with DMEK for Fuchs endothelial dystrophy

Gas-Graft Coverage After DMEK: A Clinically Validated Numeric Study

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