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Michael Straiko, Mark Terry, Julia Talajic, David Davis-Boozer; Descemet’s Membrane Endothelial Keratoplasty (DMEK) : Over-stripping the graft bed promotes donor adherence. Invest. Ophthalmol. Vis. Sci. 2013;54(15):3079.
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It has been previously reported that avoiding overlap of the donor DMEK graft with the host Descemet’s membrane (DM) may promote graft adherence. Based on this suggestion, we altered our surgical technique and analyzed our results for a difference in the rate of re-bubbling procedures and primary graft failure (PGF).
This study is a retrospective review of a non-randomized surgical intervention. 52 DMEK cases were performed for Fuchs’ dystrophy eyes. 28 eyes were identified where the host was stripped smaller than the graft resulting in overlap of the graft and the host DM. 24 eyes were identified where the host was purposely stripped wider than the size of the graft to avoid overlap of the DMEK graft and host DM. The incidence of graft replacement and frequency of re-bubbling was compared between the 2 groups.
15 of 28 (53.5%) grafts that overlapped with the host DM required rebubbling. This is significantly more than the 6/24 (25%) grafts without overlap of the host DM that required rebubbling (p=0.036). There was no significant difference in the rate of PGF. There was a 10.7% PGF rate for the overlap group and 8.3% for the non-overlap group (p=1.0).
Avoiding overlap of the DMEK graft with the host DM appears to promote adherence of the graft and decrease the rate of rebubbling procedures. A prospective, randomized study with a greater sample size would be advantageous to further validate this finding.
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