Re-bubbling cases show a higher endothelial cell loss post-DMEK
Analyses of data from 293 eyes undergoing uncomplicated Descemet membrane endothelial keratoplasty (DMEK) show that endothelial cell loss is greater in eyes that undergo a single re-bubbling for graft separation. The study, however, does not establish a causal association.
Reviewed by Mark A. Terry, MD
Portland, OR-Re-bubbling is needed more often after Descemet membrane endothelial keratoplasty (DMEK) than after Descemet stripping automated endothelial keratoplasty (DSAEK), and re-bubbled eyes have greater loss of endothelial cells (EC) than eyes that are not re-bubbled, according to the results of a large retrospective study conducted by Mark A. Terry, MD.
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It is unclear, however, whether or not the re-bubbling intervention itself increases EC loss or if it is simply an identifier of tissue with more compromised endothelium. Furthermore, these considerations should not deter cornea surgeons from adopting DMEK because re-bubbling after DMEK is a much simpler, safer, and faster procedure compared with re-bubbling after DSAEK, according to Dr. Terry, director of Cornea Services, Devers Eye Institute, Portland, OR.
“DMEK re-bubbles can be done safely at the slit lamp and with minimal to no disruption of your clinic because the re-bubbling takes less time than is needed to remove sutures,” he said.
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“With DSAEK, the re-bubble is done when the graft is fully detached, necessitating not only getting the bubble in the eye, but also centering the tissue and eliminating interface fluid. In DMEK, the tissue is already centered and partially attached to the recipient bed. Therefore, all that is necessary is to put an air bubble in the eye, which is done easily at the slit-lamp in just minutes using a new technique that we recently published [Sales et al, Cornea. 2016;35(4):582-585].”
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The retrospective study investigating the effect of re-bubbling on EC loss after DMEK included 293 consecutive eyes with Fuchs endothelial corneal dystrophy that underwent uncomplicated DMEK between February 2013 and January 2016 and had specular microscopy data available from baseline and follow-up at either 6 or 12 months.
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