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Philipp von Marchtaler, Julia Marina Weller, Friedrich E Kruse, Theofilos Tourtas; DMEK and graft adhesion: The influence of recipient characteristics on the rebubbling rate. Invest. Ophthalmol. Vis. Sci. 2016;57(12):1200.
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© 2017 Association for Research in Vision and Ophthalmology.
Rebubbling remains the most frequent complication after Descemet membrane endothelial keratoplasty (DMEK). It is known that the technique of recipient preparation and graft insertion/fixation influences graft adhesion. However characteristics of the donor stroma might also influence graft adhesion. To answer this question we compare rebubbling rates in patients who needed rebubbling in the fellow eye after having received rebubbling in the first eye.
A retrospective single-center study (approved locally) of 210 eyes of 105 consecutive patients who have received DMEK in both eyes for Fuchs endothelial dystrophy. Rebubbling rates after DMEK in the first eye, fellow eye as well as both eyes were analyzed.
23 of 105 patients received rebubbling in the first eye (21.9%) and 11 of 105 patients received rebubbling in the second eye (10.5%). 6 of 23 patients who needed rebubbling in the first eye also needed rebubbling in the second eye. The incidence of rebubbling in the second eye was significant higher in patients who underwent rebubbling in the first eye than in patients who did not underwent rebubbling in the first eye (p = 0.013, Fischer’s exact test).
Previous investigation has disclosed remarkable inter-individual differences between donor Descemet’s membrane in regard to anatomy and matrix composition. Here we describe that graft adhesion seems to be mediated by properties of the host stroma. The underlying mechanism could be due to differences in adhesion molecules. The clinical consequence is that patients with unilateral detachment need to be followed up more carefully after surgery in the second eye than patients with uneventful surgery in the first eye.
This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.
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