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Influence of Intraoperative Air Tamponade Time on Graft Adherence in Descemet Membrane Endothelial Keratoplasty

Santander-García, Diana MD, PhD*,†; Peraza-Nieves, Jorge MD*,†; Müller, Thomas M. MD*,†; Gerber-Hollbach, Nadine MD*,†; Baydoun, Lamis MD*,†; Liarakos, Vasilios S. MD, PhD*,†; Dapena, Isabel MD, PhD*,†; Oellerich, Silke PhD*,†; Van Dijk, Korine PhD*,†; Melles, Gerrit R. J. MD, PhD*,‡,§

doi: 10.1097/ICO.0000000000001795
Clinical Science

Purpose: To study the influence of different intraoperative air tamponade times on graft adherence after Descemet membrane endothelial keratoplasty (DMEK).

Methods: In this interventional case series, we evaluated 117 eyes with Fuchs endothelial corneal dystrophy (FECD) that underwent DMEK using intraoperative air tamponade times of 60 minutes (group I; n = 39), 45 minutes (group II; n = 39), or 30 minutes (group III; n = 39). At 1 and 6 months postoperatively, graft adherence status, endothelial cell density, central pachymetry, and postoperative complications were recorded.

Results: At 1 month, 19 of the 117 eyes (16.2%) showed a clinically significant detachment (>1/3 of the graft surface area and affecting visual axis): 6 eyes in group I (15.4%), 5 eyes in group II (12.8%), and 8 eyes in group III (20.5%) (P = 0.82). A minor detachment (<1/3 of the graft surface area and not affecting visual axis) was observed in 6 eyes in group I (15.4%), in 7 eyes in group II (17.9%), and in 4 eyes in group III (10.3%) (P = 0.82). The overall rebubbling rate was 11%, with no difference among the groups (P = 0.07). Mean endothelial cell density decrease at 6 months was 41% (±17%) (P = 0.56), whereas mean central pachymetry decreased by 23 (±10) % (P = 0.77), with no differences between the groups.

Conclusions: The incidence of graft detachment after DMEK for FECD did not differ between the eyes that had a 60-, 45-, or 30-minute intraoperative air tamponade. Reducing the intraoperative air tamponade time to 30 minutes may be considered for DMEK in eyes with uncomplicated FECD.

*Netherlands Institute for Innovative Ocular Surgery, Rotterdam, The Netherlands;

Melles Cornea Clinic Rotterdam, Rotterdam, The Netherlands;

Amnitrans EyeBank Rotterdam, Rotterdam, The Netherlands; and

§NIIOS-USA, San Diego, CA.

Correspondence: Gerrit R. J. Melles, MD, PhD, Netherlands Institute for Innovative Ocular Surgery, Laan op Zuid 88, 3071AA Rotterdam, The Netherlands (e-mail:

G. R. J. Melles is a consultant for DORC International/Dutch Ophthalmic USA and SurgiCube International. L. Baydoun and I. Dapena are consultants for DORC International/Dutch Ophthalmic USA. The remaining authors have no funding or conflicts of interest to disclose.

Received July 26, 2018

Accepted September 09, 2018

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