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Carolin Le Blanc, Sebastian Siebelmann, Ludwig Heindl, Claus Cursiefen, Philipp Steven; Immediate postoperative local Descemet membrane detachments and interface fluid pockets after DMEK vary in location and degree as shown by optical coherence tomography. Invest. Ophthalmol. Vis. Sci. 2013;54(15):3096.
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Replacement of diseased endothelium by Descemet membrane endothelial keratoplasty (DMEK) has been demonstrated to effectively treat patients with corneal endothelial diseases. Subtle clinical undetectable residual interface fluid may be present at the end of surgery, possibly representing a risk for post-operative entire graft detachment or limitation in visual restoration. To detect residual clinically undetectable interface fluid and graft detachment early after DMEK
10 patients (2 male/8 female) undergoing DMEK surgery at the Department of Ophthalmology, University of Cologne were examined 3-4 hours, 5-7 hours and 7-9 hours after DMEK surgery using both a time-domain OCT (SL-OCT, Heidelberg Engineering, Heidelberg, Germany) and a spectral-domain OCT (Spectralis, Heidelberg Engineering, Heidelberg, Germany). Parameters included presence, localization and potential reduction of graft detachment.
In all patients and at all time points localized graft detachment and subtle clinically undetectable interface fluid was observed. Graft detachments were localized at different positions of the cornea in between the examinations and featured different degrees. Detachments were better visualized by spectral domain OCT than by time domain OCT.
In the first hours after DMEK surgery, interface fluid and graft detachment is present in all cases despite nearly complete anterior chamber air-fill. Inconsistent localization of detachments is thought to be caused by interface fluid shift due to air bubble movement within the eye. These findings suggest considerable tissue rearrangements early after DMEK despite nearly complete anterior chamber air filling.
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