Rate of Endothelial Cell Loss and Graft Survival in Descemet Membrane Endothelial Keratoplasty in Eyes Requiring a Rebubble

Purpose:We aimed to compare the rate of 6-month endothelial cell loss (ECL) and 6-month graft survival in eyes that did not require a postoperative rebubble with eyes that did require a postoperative rebubble after Descemet membrane endothelial keratoplasty (DMEK) surgery.Methods:A consecutive series of DMEK surgeries performed from September 2013 to March 2020 was retrospectively analyzed. Eyes that did not require a rebubble for graft detachment were compared with eyes with 1 rebubble and eyes with 2 or more rebubbles for 6-month ECL and graft survival. A subanalysis of the rebubble rate for different indications for transplantation was also performed.Results:One thousand two hundred ninety-eight eyes were included in this study. The 6-month ECL for eyes with no rebubbles, 1 rebubble, and & GE;2 rebubbles was 29.3% & PLUSMN; 16.2% (n = 793), 36.4% & PLUSMN; 18.6% (n = 97, P = 0.001), and 50.1% & PLUSMN; 19.6% (n = 28, P < 0.001), respectively. The 6-month graft survival rate for eyes with no rebubbles, 1 rebubble, and & GE;2 rebubbles was 99.5%, 97.8% (P = 0.035), and 81.8% (P < 0.001), respectively. When compared to the rebubble rate for DMEK for Fuchs dystrophy (156/1165 eyes = 13.4%), the rebubble rates were statistically higher for DMEK for failed penetrating keratoplasty (28.5%, P = 0.021) and pseudophakic bullous keratopathy (28.0%, P = 0.036).Conclusions:Eyes undergoing any rebubble procedure in the postoperative period after DMEK have an increased risk of endothelial cell loss and graft failure at 6 months postoperative. DMEK in eyes for failed penetrating keratoplasty and failed DMEK had the highest rebubble rate, with the former reaching statistical significance.

Automated summary

The study aimed to compare the 6-month endothelial cell loss and graft survival in eyes that did not require a postoperative rebubble with eyes that did require a rebubble after DMEK surgery. The results showed that eyes requiring a rebubble had higher rates of endothelial cell loss and lower graft survival at 6 months postoperative, with higher rebubble rates in eyes with failed penetrating keratoplasty and pseudophakic bullous keratopathy.