Graft Detachment Following Dmek Surgery: To Re-Bubble Or Not To Re-Bubble?

The aim of this study is to investigate the graft survival rates and clinical outcomes of detached grafts in early postoperative period after Descemet Membrane Endothelial Keratoplasty (DMEK), which required re-bubbling with gas (SF6)/air, or just observed. 

Basaksehir Cam and Sakura City Hospital, Department of Ophthalmology, Istanbul, Turkey. Patients' demographic data and clinical characteristics, such as indications for DMEK, preoperative best-corrected visual acuity (BCVA) values, and times to re-bubbling postoperatively were recorded. 

Clinical records of 31 eyes with graft detachment following DMEK surgery performed by a single surgeon between 2021 and 2023 were retrospectively reviewed. The eyes were separated into two groups due to the treatment of graft detachment: Group A consisted of 20 eyes undergoing re-bubbling with SF6 or air and Group B consisted of 11 eyes which were followed by relying on the expectation of spontaneous adherence. The anatomical success was evaluated using anterior segment OCT and graft detachment degrees were classified as 3, 3 to 6, and more than 6 quadrants due to its ratio per total corneal diameter by clock quadrants. In all groups, final BCVA values (logMAR), changes in central corneal thickness and graft survival rates were evaluated.

Postoperative follow-up time was 11.48±9.23 months. In group A, 44.4% of detachments covered more than 6 quadrants, with 69.2% involving the central cornea. In contrary, in group B, detachments occurred predominantly in the superior region (63.6%), spanning 3 to 6 quadrants (54.5%). There was a significant improvement in BCVA (A:p<0.001, B:p<0.001) and corneal thickness compared to the preoperative values (A:p=0.005, B:p=0.005), although there was no significant difference between two groups. In subgroup analysis, the eyes with various degrees of detachment were compared and no significant difference was detected in terms of final BCVA and corneal thickness between Group A and B.Graft survival rates were 96% in Group A and 91% in Group B.

Re-bubbling is a common treatment option for early graft detachment following DMEK surgery. However, it may be beneficial to carefully evaluate the situation with the assistance of anterior segment OCT in order to determine whether spontaneous attachment can be achieved. This will help to reduce potential endothelial damage and the need for consecutive surgeries.