‘No Nonsense’ Dmek: Safety And Efficacy Of Postureless Dmek With Deferred Post-Operative Review Until One Week

To evaluate the clinical results of postureless (no intraoperative or postoperative posturing) Descemet membrane endothelial keratoplasty (DMEK) with the first post-operative review conducted at one week.

Design: Retrospective, noncomparative, interventional case series.

Participants: 37 consecutive eyes of 36 patients requiring DMEK with PI for any cause of endothelial failure.

Intervention: DMEK was performed with an intraoperative inferior PI and a near total fill of SF6 (20% concentration). After filling the anterior chamber with gas there was no intraoperative tamponade time; at the conclusion of surgery the patient was sat up in theatre and an external eye examination was performed to confirm the gas meniscus was above the PI. The patient was allowed home immediately with no instructions to posture at home and the next scheduled review occurred at day

Main Outcome Measures: Rate of any post-operative complications, including any unplanned visits or intervention between day 0-7, graft detachment, rebubbling and primary failure rates.

There were two unplanned visits ( pupil block required paracentesis ) and ( pain secondary to ruptured bullae ) prior to routine visit at day 7 . No Urrets-Zavalia syndrome occurred. Partial (<1/3 DMEK surface area) detachment occurred in the first month in 6/34 (17.6%) of which a rebubbling was performed in 4 (11.7%). Each of those required one rebubbling, after which total graft attachment was achieved. There were no cases of primary graft failure.                                                                                                                    

This small series highlights that DMEK surgery can be safely performed with less demands of patients in the post operative period for hospital reviews or of posturing.