Rebubbling Techniques for Graft Detachment After Descemet Membrane Endothelial Keratoplasty
Por:
Fernández López E, Baydoun L, Gerber-Hollbach N, Dapena I, Liarakos VS, Ham L and Melles GR
Publicada:
1 jun 2016
Categoría:
Ophthalmology
Resumen:
Purpose:To describe rebubbling techniques in eyes with a visually
significant graft detachment after Descemet membrane endothelial
keratoplasty (DMEK).Methods:Retrospective observational analysis at a
tertiary referral center. A total of 41 eyes (39 patients) received
rebubbling: 39 eyes (37 patients) had 1 and 2 eyes had 2 rebubbling
procedures. Anterior segment optical coherence tomography and surgical
videos were used to determine the best incisional approach for air
injection, intraoperative maneuvers, and success rate (graft
reattachment) at 1 week postoperatively.Results:Rebubbling was performed
on average 26 (21) days (range: 7-92 days) after DMEK. Graft edge
visibility and configuration of graft detachment were important
parameters for the incisional approach for air injection: the air
cannula was introduced in the area of graft attachment (attached area
approach) (n = 25) or detachment (detached area approach) (n = 16).
After excluding upside-down grafts (n = 3), the rebubbling success rate
in total was 87% (33/38 eyes); in the attached area approach, it was 92%
(22/24 eyes); and in the detached area approach, it was 79% (11/14). Of
14 eyes that had rebubbling later than 1 month postoperatively, 11 were
successful; in 8 eyes, the graft seemed too stiff and/or immobile to
allow complete unfolding.Conclusions:Rebubbling is a feasible procedure
to manage graft detachment after DMEK if the graft is correctly
oriented. Proper preoperative planning may aid in minimizing
intraoperative complications and may increase the success rate. Late
interventions (>1 month postoperatively) may still produce graft
reattachment, but increased graft stiffness and/or fibrosis may
complicate complete graft unfolding.
Filiaciones:
:
*Netherlands Institute for Innovative Ocular Surgery, Rotterdam, the Netherlands
†Melles Cornea Clinic Rotterdam, Rotterdam, the Netherlands
and ‡Amnitrans Eye Bank Rotterdam, Rotterdam, the Netherlands
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