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Sebastian Siebelmann, Sebastian Lopez Ramos, Paula Scholz, Mario Matthaei, Silvia Schrittenlocher, Ludwig M Heindl, Björn Bachmann, Claus Cursiefen; Graft attachment after Descemet Membrane Endothelial Keratoplasty (DMEK) comparing two different anterior chamber tamponades. Invest. Ophthalmol. Vis. Sci. 2018;59(9):2900.
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20% sulfurhexafluoride (SF6) has been reported to facilitate lower rebubbling rates after DMEK, when compared to normal room air as anterior chamber tamponade. Nonetheless the underlying mechanisms are not completely understood. The study presented here compares graft detachment patterns after DMEK by comparing two different anterior chamber tamponades.
Retrospective analysis of 204 consecutive patients, who underwent DMEK and received either 100% room air or 20% SF6 as anterior chamber tamponade. Read-out parameters were number, diameter and axial depth and localization of the detachments of the graft. Moreover, we compared postoperative visual acuity (BSCVA), central corneal thickness (CCT), endothelial cell count (ECC) and number of rebubblings after 1 week (T1), 1 (T2), 3 (T3), 6 (T4) and 12 (T5) months after surgery.
The air group showed more and larger detachments: Mean number: T1 n=2.9(1.6) vs. 3.7(1.9) p=0.011, T2 n= 1.6(1.4) vs. 2.3(1.6), p=0.001, T3 n=1.0(1.0) vs. 2.0(1.4), p<0.001, T4 n=0.7(1.1) vs. 1.7(1.7), p=0.002, T5 n=0.7(1.1) vs. 1.6(1.1), p>0.001; depth(mm): T1=184.5(152.6) vs. 277.5(298.9), p=0.011, T2=122.6(143.3) vs. 169.5(180.4), p=0.03, T3=77.13(100.0) vs. 110.3(116.8), p=0.061, T4=52.6(103.2) vs. 86.0(131.3), p=0.009, T5=114.6(436.1) vs. 89.2(122.3), p=0.003; diameter(mm): T1=1452.8(1365.1) vs. 2300.0(1684.6), p>0.001, T2=1100.7(1378.7) vs. 1505.1(1533.5), p=0.028, T3=703.9(1212.3) vs. 986.1(1294.8), p=0.017, T4=248.3(597.9) vs. 609.8(936.8), p>0.001, T5=296.6(479.7) vs. 733.4(1105.4), p=0.001. Patients who received SF6 were fewer treated with a rebubbling, when compared to air (12.1% vs. 29.1%, p=0.003). Postoperative ECC, CCT or BSCVA did not differ.
The lower rebubbling rate, when using SF6 as anterior chamber tamponade after DMEK could be facilitated by a more stable graft attachment, when compared to room air. Future studies should concentrate on wound healing mechanisms and graft plasticity in the graft-recipient interface after DMEK.
This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.
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