Risk Factors For The Acute Complications In Descemet Membrane Endothelial Keratoplasty With Internationally Delivered Pre-Cut Tissues

We assessed risk factors for graft detachment requiring air-re-bubbling in Descemet membrane endothelial keratoplasty (DMEK) using internationally delivered pre-cut tissues.

The medical records of 52 patients who were diagnosed as bullous keratopathy (BK) and received successful DMEK with imported pre-cut grafts were retrospectively reviewed.

Average central corneal thickness of pre-DMEK and post-DMEK was 729 μm and 522 μm, respectively. About 90% of the air was injected immediately after the DMEK in all patients. The various factors of the eyes with the graft detachment within a 1 week were compared with those in the eyes without the graft detachment. Recipient factors such as indications, small-ocular dimension, pre-operative corneal edema severity, and post-operative 2 hour-intraocular pressure (IOP) and donor factors such as donor age, death-to-use interval, pre-cut-to-use interval were analyzed as risk factors.

The overall graft detachment rate was 33% (17 among 52 eyes). Fuchs’ endothelial corneal dystrophy (FECD)-related BK showed significantly higher rate of graft detachment than in BK with other causes (p<0.01). A post-operative 2 hour-IOP of lower than 20 mmHg was significantly related to the graft detachment (p<0.01). Death-to-use interval was longer in graft-detached group than in non-detached group with a marginal significance (p=0.055). The other factors did not show significant differences between the two groups.

These findings suggest that surgical indication with a non-inflammatory FECD and post-operative 2 hour IOP are important prognostic risk factors for graft detachment that may require re-bubbling in DMEK.