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Reducing graft detachment and need for rebubbling following Descemet's membrane endothelial keratoplasty (DMEK)

Poster Details

First Author: A.Roufas UK

Co Author(s):    E. Hollick   N. Kopsachilis                 

Abstract Details


Descemet�â�€�™s membrane endothelial keratoplasty (DMEK) is a relatively new procedure to treat endothelial cell dysfunction. Previous studies have shown graft detachment rates ranging from 8.1% to 87%. In this paper we present a technique to reduce the risk of graft detachment.


A retrospective observational analysis at a tertiary referral center (Ophthalmology at King�â�€�™s College Hospital, London, United Kingdom). A total of 69 eyes underwent DMEK surgery (either DMEK alone or combined phaco / DMEK surgery) using these techniques.


Donor preparation and graft insertion were performed using previously described techniques. Once the graft was unfolded and positioned, air was injected into the anterior chamber (AC) underneath the graft. All corneal incisions, including the paracenteses, were then tightly sutured with 10/0 Nylon sutures. The AC was then completely filled with air to higher than physiological intraocular pressure (IOP) and this was left in place for 10 minutes. Some air was then released in order to achieve physiological IOP.


In our series, 20 cases had an area of interface fluid postoperatively (20/69, 29.0%). Of these, 16 resolved spontaneously, 2 required rebubbling (2/69, 2.9%), and 2 were primary failures. IOP was above 30 mmHg in 3 patients 1.5 hours postoperatively, requiring a small amount of air to be released. The mean endothelial cell loss at 1 month was 28.92 �Â�± 13.97%, which is comparable with current literature, suggesting that the pressure used to attach the graft is not causing increased cell loss.


We present the lowest rebubbling rate after DMEK surgery in the literature (2.9%). We suggest that suturing of all the corneal incisions and increasing the IOP for 10 minutes may help prevent graft detachment. The sutures prevent premature loss of any air during the period of raised IOP and when squeezing or pressing on the eye in the first few days after surgery.

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