Anatomical Behaviour, Visual Outcomes, And Predictors Of Graft Detachment And Rebubbling After Descemet Membrane Endothelial Keratoplasty (Dm) In Naïve Eyes.

To evaluate anatomical behaviour, visual outcomes, and predictors of graft detachment and rebubbling after Descemet membrane endothelial keratoplasty (DMEK) in naïve eyes with a successful outcome in a multicentre cohort.

This multicentre retrospective study was conducted at a tertiary referral centre in the United Kingdom and a high-volume corneal centre in Turkey. 

This multicentre retrospective study included naïve eyes undergoing successful DMEK at a tertiary teaching hospital in the United Kingdom and a high-volume corneal centre in Turkey. Postoperative detachments were classified by location, severity (≤1/3, 1/3–2/3, ≥2/3), and extent on anterior segment OCT (number of detached quadrants). Outcomes were compared between eyes with and without detachment and, within detached eyes, between those requiring re-bubbling and those that reattached spontaneously. Multivariable logistic regression was used to assess independent predictors.

74 eyes were analysed (mean age 71.0 ± 9.5 years); Fuchs endothelial corneal dystrophy (FECD) was the primary indication (78.3%). Early postoperative graft detachment occurred in 30 eyes (40.5%), whereas the total rebubbling rate was 24%. Detachments were most commonly inferior (43.3%), mild (≤1/3 graft area; 60.0%), and limited to a single quadrant (53.3%). Detachment occurred more frequently in FECD than in other indications (55.8% vs 4.8%, p < 0.001).On multivariable analysis, increasing patient age was independently associated with a lower risk of graft detachment (OR = 0.88 per year; 95% CI 0.78–0.99; p = 0.038). Mean BCVA improved from 0.96 ± 0.62 logMAR preoperatively to 0.21 ± 0.18 at 12 months (p = 0.007).

Overall, the only categorical factor significantly associated with postoperative graft detachment was the underlying conreal disease, with detachment occurring markedly more frequently in eyes with FECD than in other indications (p < 0.001). Apart from this, no other demographic, ocular, surgical (including unfolding time), or donor-related categorical variables were associated with detachment. Using the Wilcoxon signed-rank test, postoperative BCVA was significantly better than preoperative BCVA at all postoperative time points. These findings confirm a consistent and clinically meaningful improvement in visual acuity after successful DMEK in naïve eyes, with functional gains maintained throughout the first postoperative year.