Abstract
Purpose :
Descemet stripping automated endothelial keratoplasty (DSAEK) and Descemet membrane endothelial keratoplasty (DMEK) have become adopted worldwide as an alternative to full-thickness penetrating keratoplasties when only the corneal endothelium needs to be replaced, however due to differences in surgical techniques and patient populations, the risk factors associated with DSAEK and DMEK graft detachment requiring rebubbling have not been well characterized. In this retrospective, observational study, we sought to comprehensively identify and stratify the risk factors for both DSAEK and DMEK graft detachments that required rebubbling in the early and late post-operative periods at our academic institution.
Methods :
A retrospective analysis was conducted on all endothelial keratoplasties done at our institution over a 9-year period, totaling over 1400 consecutive DSAEK/DMEK procedures. Preoperative factors such as patients’ medical, ocular, and ocular surgical histories, type of keratoplasty performed, and donor tissue characteristics was obtained. Intraoperative factors including preparation of donor tissue, tissue insertion technique, tamponading agent used, and source of donor tissue was also obtained. Finally, postoperative outcomes were tracked, including visual acuity, intraocular pressure, graft dislocations and detachments, number of rebubbles done, and postoperative complications. Statistical significance was defined as α = 0.01.
Results :
Preliminary statistical analysis of the data shows an increased graft detachment rate with the use of thinner donor tissue (p=0.0002) and if the donor had insulin-dependent diabetes (p=0.0031). The detachment rate was also increased when surgeons used SF6 10% bubbles (p=0.033) and pre-loaded tissue grafts (p=0.019). Within DSAEKs, sub-100 micron thickness grafts were observed to have a higher rate of detachments requiring rebubbling (p=0.0037).
Conclusions :
Certain risk factors including donor diabetic status, concentration of intraoperative gas, and thickness of DSAEK graft may increase the risk for graft detachment requiring rebubbling. The results of this study may help guide surgical decision-making to reduce the risk of detachments in future EK procedures.
This abstract was presented at the 2023 ARVO Annual Meeting, held in New Orleans, LA, April 23-27, 2023.