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Jeanie Paik, Anthony Guan, Angie Wen, Elaine Wu, David Ritterband, John Seedor; Relationship of time to rebubbling on attachment success for dislocated DSAEK lenticles. Invest. Ophthalmol. Vis. Sci. 2014;55(13):887.
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To evaluate the relation of time from Descemet’s stripping automated endothelial keratoplasty (DSAEK) lenticle detachment to rebubbling and graft outcome. One of the most common complications of DSAEK surgery is graft dislocation with an average reported rate of 14.5%. Timing for rebubbling is based on a number of factors such as surgeon preference, operating room availability, and anesthesia timing. Some surgeons advocate for immediate rebubbling at the first sign of dislocation to restore the anatomic and physiologic relationship between corneal endothelium and stroma as soon as possible and because of concern for potential endothelial cell damage through contact with other eye structures or hardware such as intraocular lenses and glaucoma tube shunts. Other surgeons have hypothesized that the nutritive environment of the aqueous humor allows for non-urgent rebubbling. To our knowledge, no previous studies exist analyzing the relation of time to rebubbling of dislocated DSAEK grafts with graft outcome.
Retrospective chart review from 2005-2012 of 73 eyes with dislocated DSAEK lenticles that underwent rebubbling were included.
33 of 73 eyes (45%) had successful attachment at the first rebubbling. Mean time from dislocation to rebubbling was 2.2 days, ranging from 0 to 13 days. The relationship of time from dislocation to rebubbling with graft outcome was non-significant (p=0.98). There was no significant association of tube presence, lens status, or combined vitrectomy with reattachment success.
Our study showed an overall 45% successful attachment with clear cornea after rebubbling. This study did not elicit any statistically significant relationship with time from dislocation to rebubbling with graft outcome. Successful reattachment was achieved even in patients who were rebubbled up to 12 days after dislocation. Although there was a trend toward graft failure in eyes with glaucoma tube implants, it did not reach statistical significance. These findings indicate that the time to rebubbling did not affect graft outcome and may perhaps suggest a non-urgency to rebubble. This finding would allow reassurance to both surgeon and patient that successful reattachment of the graft can be achieved while allowing for optimal scheduling for the procedure. Further studies with larger sample sizes would help confirm these conclusions.
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