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Theofilos Tourtas, Julia Wessel, Bjoern Bachmann, Ursula Schlotzer-Schrehardt, Friedrich Kruse; Descemet Membrane Endothelial Keratoplasty (DMEK): Large Descemetorhexis To Reduce Rebubbling Does Not Cause Postoperative Peripheral Corneal Edema. Invest. Ophthalmol. Vis. Sci. 2013;54(15):1672.
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While DMEK renders better visual visual acuity than DSAEK, it is associated with higher rebubbling rate because of postoperative partial graft detachment. One possibility to reduce rebubbling rate is to create a larger descemetorhexis which avoids an overlap between the donor's descemet membrane and the implanted DMEK graft thus decreasing graft detachment. However, the presence of denuded stroma without descemet membrane or endothelium after large descemetorhexis might cause stromal edema. To evaluate the incidence of stromal edema in the early postoperative phase, peripheral corneal thickness was compared between patients undergoing DMEK with two different techniques.
A single-center, retrospective, consecutive case series of 30 patients undergoing DMEK for Fuchs endothelial dystrophy with two different techniques: Based on intraoperative drawings and postoperative slit-lamp examinations patients were divided into two groups. In group A (n= 16 eyes) diameter of descemetorhexis was approx. 10 mm, resulting in a 1-mm zone of denuded stroma. In group B (n= 14 eyes) diameter was approx. 6 mm, resulting in a 1-mm zone of overlapping. To assess corneal edema, peripheral corneal thickness was measured by Scheimpflug imaging (Pentacam; Oculus, Wetzlar, Germany) and anterior segment OCT in the 8 mm zone within a 2-month follow-up.
Preoperative peripheral corneal thickness in group A was 731 ± 63 µm and in group B 706 ± 48 µm (P=.241). Two months after surgery, peripheral corneal thickness was 702 ± 45 µm and 678 ± 48 µm in groups A and B (P=.179), respectively. Peripheral corneal thickness was not significantly different between both groups, 2 months after surgery. Rebubbling rate was 12.5% in group A and 21.4% in group B.
DMEK with larger descemetorhexis leaving a small zone of denuded stroma cause significantly enhanced graft adhesion without increasing the incidence of peripheral corneal edema.
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