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Stephan Riss, Michael Rudolph, Michaela Moelle, Kathrin Laaser, Bjoern Bachmann, Claus Cursiefen, Friedrich E. Kruse; An Improved Standardized Insertion Technique Significantly Reduces Rebubbling Rate in Descemet Membrane Endothelial Keratoplasty (DMEK). Invest. Ophthalmol. Vis. Sci. 2012;53(14):60.
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To describe a new surgical approach to enhance graft adherence and to reduce the rate of additional air injections in Descemet Membrane Endothelial Keratoplasty (DMEK).
Retrospective chart analysis of 100 eyes of 100 patients with Fuchs endothelial dystrophy was performed. Patients were divided into two groups according to the insertion method used to deliver the Descemet roll. In both groups a Zeiss IOL Shooter was used for graft insertion. In group A a small air bubble (200 µl) was injected in the Descemet roll to facilitate unfolding and orientation of the graft in the anterior chamber. In group B DMEK was performed without an additional air bubble. Main outcome measures included best corrected visual acuity (BSCVA), endothelial cell count (ECC), central corneal thickness (CCT) preoperatively, 4 weeks and 3 months postoperatively and number of additional air injections in case of graft detachement.
BSCVA in both groups increased from 20/80 ± 20/125 preoperatively to 20/32 ± 20/80 at 3 months postoperatively. ECC decreased from 1548 ± 237 cells/mm2 (group A) and from 1494 ± 234 cells/mm2 (group B) at 4 weeks to 1381 ± 457 cells/mm2 (group A) and to 1388 ± 280 cells/mm2 (group B) at 3 months postoperatively.CCT reduced from 689 ± 126 µm (group A) and from 643 ± 98 µm (group B) preoperatively to 540 ± 53 µm (group A) and 531 ± 64 µm (group B) at 3 months postoperatively.There was no significant difference (p > 0.05) considering BSCVA, ECC and CCT between both groups at any time point.40 patients received one air injection (group A n = 11; group B n = 29), 10 patients received 2 air injections (group A n = 2; group B n = 8) and 2 patients received 3 air injections (group A n = 1; group B n = 1) in the early postoperative stage due to partial donor detachment. 34 patients did not need any air injection (group A n = 24; group B n = 10). Rebubbling rate in group A was significantly lower than in group B (p < 0.001).
The use of the Zeiss IOL Shooter combined with the insertion technique allows standardization of the insertion and orientation of the graft. This technique facilitates unfolding the graft, enhances graft adherence and reduces rebubbling rate significantly.
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