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Bjoern O Bachmann, Kathrin Roessler, Theofilos Tourtas, Julia M Weller, Ursula Schlotzer-Schrehardt, Friedrich E Kruse; The Influence of Hypertonic Sodium Chloride Eye Drops on the Early Postoperative Course after Descemet Membrane Endothelial Keratoplasty (DMEK). Invest. Ophthalmol. Vis. Sci. 2014;55(13):883.
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© ARVO (1962-2015); The Authors (2016-present)
The sole replacement of Descemet's membrane and corneal endothelium (DMEK) allows for rapid visual recovery within weeks after surgery in patients with corneal endothelial diseases. The postoperative treatment regimen is generally not well standardized but frequently includes the use of hypertonic saline eye drops. Whether these eye drops beneficially affect the postoperative course after DMEK (accelerated visual recovery, faster corneal deswelling, decreased rebubbling rate) has not been evaluated so far.
We retrospectively compared 15 consecutive patients after DMEK receiving hypertonic 5% sodium chloride eye drops five times a day for 1 month (group 1) to 15 patients without hypertonic eye drop treatment (group 2). Best spectacle corrected visual acuity (BSCVA), pachymetry (Pentacam®, Oculus, Germany) and corneal endothelial cell density (SeaEagle®, Rhine-Tec GmbH, Germany) were analyzed during the first postoperative month.
LogMAR BSCVA were 0.71 (± 0.32) / 0.62 (± 0.21) preoperatively, 0.67 (± 0.33) / 0.54 (± 0.15) 1 week and 0.43 (± 0.29) / 0.3 (± 0.17) 1 month after DMEK in patients postoperatively treated with / without hypertonic saline eye drops (no statistically significant difference at all time points between both groups). Corneal thickness decreased from 594 µm (± 50) before to 543 µm (± 56) at 5 days and 502 µm (± 36) at 1 month after DMEK in patients from group 1 compared to 605 µm (± 54) before to 548 (± 50) at 5 days and 512 µm (± 33) at 1 month after DMEK in patients from group 2 (no statistically significant difference between both groups at all time points). The postoperative corneal endothelial cell loss 1 month after DMEK were 42 % in patients from group 1 and 40 % in patients from group 2. None in group 2 received additional postoperative rebubblings compared to 4 patients in group 1. Clinically there was a faint beneficial effect of hypertonic eye drops on the frequency of central stromal edema 5 days after DMEK (3 out of 11 in group 1 vs. 5 out of 15 in group 2).
The treatment with hypertonic saline eye drops after DMEK does not accelerate the visual recovery or the corneal deswelling process nor does it reduce the need of additional rebubblings after DMEK. A possibly positive effect of hypertonic eye drops on the short term corneal clarity after DMEK has to be shown in a larger study series.
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