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Factors associated with early detachment in primary Descemet's membrane endothelial keratoplasty

Poster Details

First Author: P.Leon ITALY

Co Author(s):    M. Parekh   Y. Nahum   M. Mimouni   B. Filipovich-Ricci   R. Spena   C. Bovone     

Abstract Details

Purpose:

To evaluate the potential factors of early graft detachment in Descemet Membrane Endothelial Keratoplasty (DMEK).

Setting:

Fondazione Banca degli Occhi del Veneto (Mestre, Italy) and Villa Igea Private Hospital (Forl�Ã�¬, Italy)

Methods:

One hundred and seventy-three eyes of 173 patients that underwent DMEK as a single procedure or in combination with phacoemulsification and IOL implantation were included. In surgery pre-stripped DMEK grafts, 8.25mm in diameter were tri-folded with endothelium inwards, loaded into an intraocular lens cartridge and delivered using a bimanual pull-through technique. At the end of surgery, the anterior chamber was filled completely with air that was eventually removed 3 hours later only if pupillary block was suspected. Re-bubbling was performed in all cases with graft detachment, independently of its extension. Donor and recipient characteristics affecting graft detachment were recorded.

Results:

The combination of DMEK with cataract removal and IOL implantation (P=0.002) and; the amount of air in the anterior chamber in the early postoperative period [�â�‰�¤75% at 2-3 hours (P=0.027) and �â�‰�¤50% at 24 hours (P=0.014)] were found to be 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 re-bubbling. Air level in the anterior chamber should be monitored and maintained above 75% in early hours following surgery.

Financial Disclosure:

NONE

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