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Rebubbling and graft failure in descemet membrane endothelial keratoplasty: a prospective dutch registry study

Poster Details

First Author: S.Dunker THE NETHERLANDS

Co Author(s):    B. Winkens   F. van den Biggelaar   R. Nuijts   P. Kruit   M. Dickman        

Abstract Details


To identify risk factors for rebubbling early graft failure after DMEK.


Multicenter registry study.


In this registry study, all consecutive DMEK procedures registered in the The Netherlands Organ Transplant Registry (NOTR) from October 5th, 2011 until May 31st, 2018 were assessed (n=752). Univariable and multivariable analysis was performed using logistic regression. The effect of rebubbling on endothelial cell density was analyzed using a linear mixed model.


In multivariable analysis, independent risk factors for rebubbling were surgical complication (Odds Ratio [OR]: 2.28, 95% confidence interval [CI], 1.20 – 4.33, P=0.012) and older recipient age (OR: 1.04 [per increase of 1 year], 95% CI, 1.01 – 1.07, P=0.003). Risk factors for developing graft failure within three months were transplant before 2016 (OR: 3.32, 95% CI, 1.87 – 5.90, P<0.001), and surgical complication (OR: 2.93, 95% CI, 1.42 – 6.04, P=0.004). Throughout the study period, rebubbling and early graft failure were inversely related. Eyes that underwent rebubbling showed significantly lower endothelial cell densities at 3, 6 and 12 months compared to eyes that did not undergo rebubbling (all P<0.001).


This real-world Dutch registry study identified independent risk factors for DMEK graft detachment leading to rebubbling, namely recipient age and surgical complication, and early graft failure, namely transplantation before 2016 and surgical complication. Rebubbling was associated with significantly higher endothelial cell loss in the first year after surgery.

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