Effectiveness Of Enoxaparin In Preventing Intraoperative Fibrin Formation During Dmek: A Before-And-After Study.
Published 2025 - 43rd Congress of the ESCRS
Reference: FP07.13 | Type: Free paper | DOI: 10.82333/16zb-jx13
Authors: Rafael I. Barraquer* 1 , Teresa Gacia-Berrocoso 2 , Eduardo Chicano-Galvez 3 , Ricardo Cuiña 4 , Margarita Cabanás 5 , Alexandra Arango 6 , Josep Torras 7 , Daniela Ortiz 8
1Barraquer Institute,Barcelona,Spain, 2Cornea Project S.L.,Sitges,Spain, 3IMIBIC,Cordoba,Spain, 4hospital Clinico San Carlos,Madrid,Spain, 5hospital Universitario Virgen del Rocio,Sevilla,Spain, 6hospital universitari Germans Trias i Pujol,Badalona,Spain, 7Hospital clinic de Barcelona,Barcelona,Spain, 8Hospital Universitari Joan XXIII,Tarragona,Spain
Purpose
To demonstrate that enoxaparin in the irrigation saline solution can effectively prevent intraoperative fibrin formation (IFF) during Descemet membrane endothelial keratoplasty (DMEK) surgery without compromising graft viability, visual recovery, or intraoperative safety.
Setting
Ramón y Cajal University Hospital (Madrid, Spain)
Department of Ophthalmology. Head of Cornea unit. Cruces University Hospital. Barakaldo. Spain
“La Mancha-Centro” hospital. Department of Ophthalmology Alcázar de San Juan. Spain
Methods
A "before-and-after" study was conducted, comparing the rate of IFF in a prospective cohort of DMEK cases treated with enoxaparin to a retrospective cohort without treatment. Donor cornea characteristics, surgical data, rebubbling rate, final endothelial cell density (ECD), and best corrected visual acuity (BCVA) were analyzed.
Results
A total of 265 cases were analyzed. The incidence of IFF was 5.43% in the cohort without enoxaparin and zero in the enoxaparin-treated cohort. The risk ratio for enoxaparin use was 0 (confidence interval: 0), with a risk difference of -0.054 and a number needed to treat (NNT) of 18.42 cases to prevent one IFF event. No significant differences were found in baseline patients features or surgical aspects. The rebubbling rate was 16.98%, with no statistically significant difference between groups. No significant differences were observed in final ECD or BCVA between groups. In addition, no intraoperative complications or intraocular bleeding occurred with enoxaparin administration.
Conclusions
Enoxaparin is a safe, effective, and cost-efficient prophylaxis for preventing IFF during DMEK surgery. It impedes the development of IFF, which may require a new and costly transplant when it occurs.