Department of Ophthalmology, University of Leipzig Medical Center, Leipzig, Germany.
The University Hospital of Ophthalmology, Inselspital, Bern, Switzerland.
Eur J Ophthalmol. 2023 May;33(3):1347-1353. doi: 10.1177/11206721221146579. Epub 2022 Dec 19.
To investigate the need of rebubbling for small graft detachments after Descemet Membrane Endothelial Keratoplasty (DMEK).
In this retrospective study we evaluated 111 eyes from 111 patients that showed graft detachment after DMEK surgery and have achieved graft adherence by injection of air or 20% sulfur hexafluoride (SF) to the anterior chamber (rebubbling group; n = 57) or by spontaneous adherence without intervention (control group; n = 54) at final examination. Subgroups in terms of the maximum height and in terms of the detachment area in relation to graft area were formed. Outcome measures were the increase in best-corrected visual acuity (BCVA) and the decrease in central corneal thickness (CCT) from the measurement before DMEK to six months after surgery and postoperative endothelial cell density.
BCVA increased in the rebubbling group and the control group, the difference being 0.22 logMAR, = 0.048. For eyes with a maximum height less than 500µm, the increase of BCVA was 0.39 ± 0,36 logMAR in the control group and 0.62 ± 0,53 logMAR in the rebubbling group, = 0.045. There was no difference of statistical significance of BCVA between both groups regarding the detachment area of less than 20% in relation to graft area. The mean decrease in CCT and postoperative endothelial cell density showed no significant difference between the rebubbling group and the control group.
Compared to spontaneous graft adherence, a rebubbling shows no beneficial effect on the clinical outcome for small detached DMEK grafts. Rebubbling does not decrease postoperative endothelial cell density.
研究在穿透性角膜内皮移植术（DMEK）后，对于小面积的基质内角膜移植片脱离，是否需要重新注气。
本回顾性研究评估了 111 例 111 只眼，这些眼在 DMEK 手术后出现了基质内角膜移植片脱离，通过向眼前房注射空气或 20%六氟化硫（SF）（重新注气组；n=57）或自行贴合（未干预组；n=54），最终检查时基质内角膜移植片均已贴合。按最大高度和脱离面积与移植片面积的比值进行分组。测量指标包括从 DMEK 术前至术后 6 个月最佳矫正视力（BCVA）的增加和中央角膜厚度（CCT）的减少以及术后内皮细胞密度。
重新注气组和未干预组的 BCVA 均有增加，差异为 0.22 logMAR，P=0.048。对于最大高度小于 500µm 的眼，未干预组 BCVA 的增加为 0.39 ± 0.36 logMAR，重新注气组为 0.62 ± 0.53 logMAR，P=0.045。对于脱离面积小于移植片面积 20%的眼，两组间 BCVA 无统计学差异。重新注气组和未干预组间 CCT 的平均减少和术后内皮细胞密度无显著差异。
与自发贴合相比，重新注气对小面积基质内角膜移植片脱离的临床结果没有有益影响。重新注气不会降低术后内皮细胞密度。
