Official ESCRS | European Society of Cataract & Refractive Surgeons


Air vs sulphur hexaflouride in DMEK: a randomised controlled trial

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Session Details

Session Title: Cornea Surgical: Lamellar Corneal Grafts

Session Date/Time: Tuesday 17/09/2019 | 08:30-10:30

Paper Time: 09:36

Venue: Free Paper Forum: Podium 3

First Author: : J.Cabrerizo Nunez DENMARK

Co Author(s): :    G. Özer   M. Kyhn   K. Højgaard-Olsen   M. la Cour   J. Cabrerizo                 

Abstract Details


To determine whether sulphur hexaflouride (SF6) is superior to air in Descemets Membrane Endothelial Keratoplasty (DMEK).


Rigshospitalet - Glostrup, Denmark


This is a single-center, double-blind, randomized controlled trial. Since September 2017 participants underwent DMEK, either single procedure or combined with cataract surgery, and were randomly allocated to either intracameral air or SF6. The primary (superior) outcome was clinically significant graft detachment (1/3 graft detachment at one week) and rebubble rate. The sample size was based on an estimated a 55% success rate with air and a 80% success rate with SF6. The secondary outcome was visual acuity and endothelial cell count at 3 months. Additionally, gas fill and postoperative patient positioning were measured objectively.


104 participants were enrolled. Preliminary analysis of 91 participants demonstrated similar rebubble rates in both treatment groups: 12/44 (72.7%; 95% CI: 58.2–83.7) and 11/47 (76.6%; 95% CI: 62.8–86.4) in the air and SF6 group, respectively. Mean decimal visual acuity at 3 months was 0.81 (SD 0.18) in the air group and 0.73 (SD 0.23) in the SF6 group (p = 0.16). Endothelial cell count was 1384 cells/mm2 (SD 558) in air and 1544 cells/mm2 (SD 657) in SF6 group (p = 0.39). We observed no significant difference in the occurrence in adverse events between the groups.


SF6 was not shown to significantly reduce the rebubble rate compared to air in DMEK. The objective measuring of gas fill and postoperative patient positioning aided our understanding of the DMEK procedure.

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