June 2023
Volume 64, Issue 8
Open Access
ARVO Annual Meeting Abstract  |   June 2023
Risk Factors for Detachments Requiring Rebubbling Following Endothelial Keratoplasties Performed at an Academic Institution
Author Affiliations & Notes
  • Osamah T. Mian
    The University of Oklahoma College of Medicine, Oklahoma City, Oklahoma, United States
  • Jacob Warmath
    The University of Oklahoma College of Medicine, Oklahoma City, Oklahoma, United States
    Dean McGee Eye Institute, Oklahoma City, Oklahoma, United States
  • Umar Sandhu
    The University of Oklahoma College of Medicine, Oklahoma City, Oklahoma, United States
  • Michael heath
    The University of Oklahoma College of Medicine, Oklahoma City, Oklahoma, United States
    Dean McGee Eye Institute, Oklahoma City, Oklahoma, United States
  • Anushka Raj
    The University of Oklahoma College of Medicine, Oklahoma City, Oklahoma, United States
  • Kai Ding
    The University of Oklahoma College of Medicine, Oklahoma City, Oklahoma, United States
    Dean McGee Eye Institute, Oklahoma City, Oklahoma, United States
  • Kamran M Riaz
    The University of Oklahoma College of Medicine, Oklahoma City, Oklahoma, United States
    Dean McGee Eye Institute, Oklahoma City, Oklahoma, United States
  • Footnotes
    Commercial Relationships   Osamah Mian None; Jacob Warmath None; Umar Sandhu None; Michael heath None; Anushka Raj None; Kai Ding None; Kamran Riaz Ambrx Pharmaceuticals, ImmunoGen, Code C (Consultant/Contractor), CorneaGen, Bausch and Lomb, Code R (Recipient)
  • Footnotes
    Support  None
Investigative Ophthalmology & Visual Science June 2023, Vol.64, 4806. doi:
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    • Get Citation

      Osamah T. Mian, Jacob Warmath, Umar Sandhu, Michael heath, Anushka Raj, Kai Ding, Kamran M Riaz; Risk Factors for Detachments Requiring Rebubbling Following Endothelial Keratoplasties Performed at an Academic Institution. Invest. Ophthalmol. Vis. Sci. 2023;64(8):4806.

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      © ARVO (1962-2015); The Authors (2016-present)

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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.

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