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Philipp von Marchtaler, Julia M Weller, Friedrich E Kruse, Theofilos Tourtas; Air versus SF6 in DMEK: a fellow eye comparison of side effects. Invest. Ophthalmol. Vis. Sci. 2017;58(8):5701.
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© ARVO (1962-2015); The Authors (2016-present)
The most common postoperative complication of Descemet membrane endothelial keratoplasty (DMEK) is graft detachment representing one of the main challenges of DMEK. By modifications of the surgical technique the rate of graft detachments can be reduced, for example by an oversized descemetorhexis or by a large air bubble. The use of sulfur hexafluoride (SF6) gas has been proposed as another method to reduce the rate of graft detachments. However, fellow-eye comparison between air- and SF6-gas filled eyes regarding side effects has not been reported until now.
136 eyes of 68 patients which underwent uneventful DMEK in both eyes were included in this study. Inclusion criteria were: air tamponade (80% of anterior chamber volume) in the first eye and SF6 gas tamponade (80% of anterior chamber volume) in the second eye; same corneal button storage method in both eyes (organ-cultured or short-term cultured). All eyes received laser iridotomy on the day before DMEK. Main outcome measures included rebubbling rate, rate of postoperative pupillary block caused by the air/gas bubble, pre- and postoperative best-corrected visual acuity (BCVA), central corneal thickness (CCT), and endothelial cell density (ECD).
13 of 68 (19.1%) eyes with air tamponade needed rebubbling compared to 4 of 68 (5.9%) eyes with SF6-gas tamponade (p=0.020, chi square test). Postoperative pupillary blocks necessitating partial release of air or gas occurred in 1 eye with air tamponade and 3 eyes with SF6-gas tamponade (p=0.365, fisher's exact test). There were no significant differences in preoperative and postoperative best corrected visual acuity, central corneal thickness, and endothelial cell density.
Our results confirm better graft adhesion when using SF6 gas tamponade than air tamponade in DMEK which was previously reported. The rate of pupillary block in eyes with SF6 gas tamponade was not significant higher compared to air tamponade. As a consequence we recommend using SF6 gas tamponade in DMEK.
This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.
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