title: Rate and Localization of Graft Detachment in Descemet Membrane Endothelial Keratoplasty.
abstract: OBJECTIVE
  To investigate the rate and localization of graft detachment after Descemet membrane endothelial keratoplasty.
  
  
  METHODS
  Sixty-six consecutive cases operated between June and August 2014 at the Charité-Universitätsmedizin Berlin were examined prospectively 1 week postoperatively. A single masked observer analyzed the rate and localization of graft detachment using optical coherence tomography (OCT), and the rebubbling rate was measured. Localization of graft detachment was correlated to the incision approach. Preoperative data were correlated to the rate of graft detachment and rebubbling.
  
  
  RESULTS
  Graft detachment occurred in more than 2 clock hours and with postoperative corneal edema in 33.3% and required rebubbling. In 33.3%, graft detachment occurred in more than 2 clock hours and with postoperative corneal edema and required rebubbling. The mean graft detachment rate was 8.3% per clock hour. A significantly higher graft detachment rate was noted in the inferior clock hours (21.1%, P < 0.0001, 16.7%, P = 0.003). Only higher age of the patient correlated to a higher rate of graft detachment (P = 0.022). No correlation was found between localization of graft detachment and the incision approach (P = 0.615).
  
  
  CONCLUSIONS
  The graft detachment rate is high after Descemet membrane endothelial keratoplasty, but detachment is usually peripheral, partial and mainly inferior and involves only a few clock hours. Only higher age of the patient is strongly associated with a higher rate of graft detachment. The incision approach is not significantly correlated with the localization of graft detachment. Therefore, the postoperative supine position of the patient seems to be of major importance.Clinical Trial Registration-URL: http://www.clinicaltrials.gov. Unique identifier: NCT02020044.
authors.affiliation: Department of Ophthalmology, Charité-Universitätsmedizin Berlin, Berlin, Germany.
authors.forename: Anna-Karina B
authors.initials: AK
authors.lastname: Maier
authors.forename: Enken
authors.initials: E
authors.lastname: Gundlach
authors.forename: Daniel
authors.initials: D
authors.lastname: Pilger
authors.forename: Anne
authors.initials: A
authors.lastname: Rübsam
authors.forename: Matthias K J
authors.initials: MK
authors.lastname: Klamann
authors.forename: Johannes
authors.initials: J
authors.lastname: Gonnermann
authors.forename: Eckart
authors.initials: E
authors.lastname: Bertelmann
authors.forename: Antonia M
authors.initials: AM
authors.lastname: Joussen
authors.forename: Necip
authors.initials: N
authors.lastname: Torun
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003316:Corneal Diseases / Q000601:surgery*; D003886:Descemet Membrane / Q000601:surgery; D057111:Descemet Stripping Endothelial Keratoplasty / Q000379:methods*; D004728:Endothelium, Corneal / Q000601:surgery; D005260:Female; D006084:Graft Rejection; D006085:Graft Survival; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology*; D011446:Prospective Studies; D012307:Risk Factors; D041623:Tomography, Optical Coherence; D014792:Visual Acuity