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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


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


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


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.


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.


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.

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