Rebubbling in Descemet Membrane Endothelial Keratoplasty: Influence of Pressure and Duration of the Intracameral Air Tamponade.
OBJECTIVE
To explore the impact of intracameral air tamponade pressure and duration on graft attachment and rebubbling rates.


METHODS
A prospective, interventional, nonrandomized study.


METHODS
setting: Department of Ophthalmology, Charité - Universitätsmedizin Berlin.


METHODS
One hundred seventeen patients who underwent Descemet membrane endothelial keratoplasty (DMEK).


METHODS
Intraocular pressure (IOP) at the end of the surgery, immediately after filling the anterior chamber with air, categorized into low (<10 mm Hg), normal (10-20 mm Hg), and high (>20 mm Hg), and the time until partial removal of the air.


METHODS
Rebubbling rates and endothelial cell density over a 3-month follow-up period analyzed by a multivariable Cox regression model and an analysis of covariance model.


RESULTS
Thirty-two patients required a rebubbling (27% [95% CI 19%-35%]). Nine patients required more than 1 rebubbling (7% [95% CI 3%-12%]). Compared with normal IOP, lower (HR 8.98 [95% CI 1.07-75.41]) and higher IOP (HR 10.63 [95% CI 1.44-78.27]) increased the risk of requiring a rebubbling (P = .006). Independent of the IOP, an air tamponade duration beyond 2 hours reduced the risk of rebubbling (HR 0.36 [95% CI 0.18-0.71, P = .003]). One month after surgery, the mean endothelial cell loss was 13% (95% CI 2%-25%) and 23% (95% CI 17%-29%) in the group with air tamponade duration of below and above 2 hours, respectively (P = .126). At 3 months after surgery, it was 31% (95% CI 17%-42%) and 42% (95% CI 32%-52%) in the respective groups (P = .229).


CONCLUSIONS
A postsurgical air tamponade of at least 2 hours with an IOP within the physiological range could help to reduce rebubbling rates.
Department of Ophthalmology, Charité - Universitätsmedizin Berlin, Berlin, Germany.
Daniel
D
Pilger
University Tissue Bank, Cornea Bank Berlin, Institute of Transfusion Medicine, Charité - Universitätsmedizin Berlin, Berlin, Germany.
Ina
I
Wilkemeyer
University Tissue Bank, Cornea Bank Berlin, Institute of Transfusion Medicine, Charité - Universitätsmedizin Berlin, Berlin, Germany.
Jan
J
Schroeter
Department of Ophthalmology, Charité - Universitätsmedizin Berlin, Berlin, Germany.
Anna-Karina B
AB
Maier
Department of Ophthalmology, Charité - Universitätsmedizin Berlin, Berlin, Germany. Electronic address: Necip.torun@charite.de.
Necip
N
Torun
D000368:Aged; D000369:Aged, 80 and over; D000388:Air; D003886:Descemet Membrane / Q000601:surgery*; D057111:Descemet Stripping Endothelial Keratoplasty / Q000379:methods*; D058450:Endotamponade / Q000379:methods*; D004728:Endothelium, Corneal / Q000473:pathology; D005260:Female; D005500:Follow-Up Studies; D005642:Fuchs' Endothelial Dystrophy / Q000503:physiopathology / Q000601:surgery*; D006085:Graft Survival; D006801:Humans; D007429:Intraocular Pressure / Q000502:physiology; D008297:Male; D008875:Middle Aged; D011312:Pressure; D011446:Prospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D014792:Visual Acuity