Skip to main content

Advertisement

SpringerLink
Log in

Predictive factors of graft detachment and rebubbling after descemet membrane endothelial keratoplasty

  • Original Paper
  • Published:
International Ophthalmology Aims and scope Submit manuscript

Abstract

Purpose

To identify risk and predictive factors associated with the need of rebubbling in the eye of patients who underwent a descemet membrane endothelial keratoplasty (DMEK).

Methods

The records of patients who underwent DMEK were retrospectively analyzed. Data regarding comorbidities, intraoperative characteristics, and postoperative treatments or complications were collected. The central corneal thickness (CCT) was measured by optical coherence tomography before and the day after DMEK. Univariate and multivariate analyses were performed.

Results

Of the 333 DMEK, rebubbling was performed in 119 cases (36%). Preoperative subepithelial fibrosis and a history of penetrating keratoplasty (PK) were associated with significantly more graft detachment [OR of 3.55 (2.02–6.32; P < 0.001) and 5.89 (2.00–21.86; P = 0.003), respectively]. A decreased CCT the day after surgery reduced by 5.7-fold the risk of rebubbling (sensitivity/specificity of 0.42/0.93). Conversely, a 20% increase in the CCT the day after surgery increased by 4.5-fold the risk of rebubbling (sensitivity/specificity of 0.42/0.91).

Conclusion

Variation of the CCT could be used as a predictive factor of rebubbling after DMEK. Patients with a 20% increase of CCT the day after surgery are at higher risk of graft detachment. Conversely, a reduced CCT the day after the surgery is associated with a reduced risk of rebubbling. Subepithelial fibrosis and history of PK were also identified as risk factors for rebubbling. Those predictive factors may help develop a customized approach for patients undergoing DMEK surgery.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

Data availability

The datasets generated and/or analyzed during the current study are not publicly available but are available from the corresponding author on reasonable request.

References

  1. Peraza-Nieves J, Baydoun L, Dapena I, Ilyas A, Frank LE, Luceri S et al (2017) Two-year clinical outcome of 500 consecutive cases undergoing descemet membrane endothelial keratoplasty. Cornea 36(6):655–60

    Article  PubMed  Google Scholar 

  2. Reid RA, Craig EA, Suleman H (2015) Descemet’s membrane endothelial keratoplasty (DMEK): first UK prospective study of 1-year visual outcomes, graft survival and endothelial cell count. Br J Ophthalmol 99(2):166–169

    Article  PubMed  Google Scholar 

  3. Dirisamer M (2011) Efficacy of descemet membrane endothelial keratoplasty: clinical outcome of 200 consecutive cases after a learning curve of 25 cases. Arch Ophthalmol 129(11):1435

    Article  PubMed  Google Scholar 

  4. Melles GRJ, Ong TS, Ververs B, van der Wees J (2008) Preliminary clinical results of descemet membrane endothelial keratoplasty. Am J Ophthalmol 145(2):222-227.e1

    Article  PubMed  Google Scholar 

  5. Price DA, Kelley M, Price FW, Price MO (2018) Five-year graft survival of descemet membrane endothelial keratoplasty (EK) versus descemet stripping EK and the effect of donor sex matching. Ophthalmology 125(10):1508–1514

    Article  PubMed  Google Scholar 

  6. Guerra FP, Anshu A, Price MO, Price FW (2011) Endothelial keratoplasty: fellow eyes comparison of descemet stripping automated endothelial keratoplasty and descemet membrane endothelial keratoplasty. Cornea 30(12):1382–6

    Article  PubMed  Google Scholar 

  7. Guerra FP, Anshu A, Price MO, Giebel AW, Price FW (2011) Descemet’s membrane endothelial keratoplasty. Ophthalmology 118(12):2368–2373

    Article  PubMed  Google Scholar 

  8. Fernández López E, Baydoun L, Gerber-Hollbach N, Dapena I, Liarakos VS, Ham L et al (2016) Rebubbling techniques for graft detachment after descemet membrane endothelial keratoplasty. Cornea 35(6):759–64

    Article  PubMed  Google Scholar 

  9. Mechels K, Greenwood M, Sudhagoni R, Berdahl J (2017) Influences on rebubble rate in descemet’s membrane endothelial keratoplasty. OPTH 11:2139–2144

    Article  Google Scholar 

  10. Maier AKB, Gundlach E, Pilger D, Rübsam A, Klamann MKJ, Gonnermann J et al (2016) Rate and localization of graft detachment in descemet membrane endothelial keratoplasty. Cornea 35(3):308–12

    Article  PubMed  Google Scholar 

  11. de Rodríguez-Calvo MM, van Groeneveld BEA, Frank LE, van der Wees J, Oellerich S, Bruinsma M et al (2016) Association between graft storage time and donor age with endothelial cell density and graft adherence after descemet membrane endothelial keratoplasty. JAMA Ophthalmol. 134(1):91–4

    Article  Google Scholar 

  12. Siebelmann S, Ramos SL, Matthaei M, Scholz P, Schrittenlocher S, Heindl LM et al (2018) Factors associated with early graft detachment in primary descemet membrane endothelial keratoplasty. Am J Ophthalmol 192:249–250

    Article  PubMed  Google Scholar 

  13. Leon P, Parekh M, Nahum Y, Mimouni M, Giannaccare G, Sapigni L et al (2018) Factors associated with early graft detachment in primary descemet membrane endothelial keratoplasty. Am J Ophthalmol 187:117–124

    Article  PubMed  Google Scholar 

  14. Tourtas T, Schlomberg J, Wessel JM, Bachmann BO, Schlötzer-Schrehardt U, Kruse FE (2014) Graft Adhesion in descemet membrane endothelial keratoplasty dependent on size of removal of host’s descemet membrane. JAMA Ophthalmol 132(2):155

    Article  PubMed  Google Scholar 

  15. Chaurasia S, Price FW Jr, Gunderson L, Price MO (2014) Descemet’s membrane endothelial keratoplasty: clinical results of single versus triple procedures (combined with cataract surgery). Ophthalmology 121(2):454–458

    Article  PubMed  Google Scholar 

  16. Dirisamer M (2012) Prevention and management of graft detachment in descemet membrane endothelial keratoplasty. Arch Ophthalmol 130(3):280

    Article  PubMed  Google Scholar 

  17. Röck T, Bramkamp M, Bartz-Schmidt KU, Röck D, Yörük E (2015) Causes that influence the detachment rate after descemet membrane endothelial keratoplasty. Graefes Arch Clin Exp Ophthalmol 253(12):2217–2222

    Article  PubMed  Google Scholar 

  18. Yuda K, Kato N, Takahashi H, Shimizu T, Oyakawa I, Matsuzawa A et al (2019) Effect of graft shift direction on graft detachment and endothelial cell survival after descemet membrane endothelial keratoplasty. Cornea 38(8):970–975

    Article  PubMed  Google Scholar 

  19. Marques RE, Guerra PS, Sousa DC, Ferreira NP, Gonçalves AI, Quintas AM et al (2018) Sulfur hexafluoride 20% versus air 100% for anterior chamber tamponade in DMEK: a meta-analysis. Cornea 37(6):691–697

    Article  PubMed  Google Scholar 

  20. Pilger D, Wilkemeyer I, Schroeter J, Maier AKB, Torun N (2017) Rebubbling in descemet membrane endothelial keratoplasty: influence of pressure and duration of the intracameral air tamponade. Am J Ophthalmol 178:122–128

    Article  PubMed  Google Scholar 

  21. Heinzelmann S, Böhringer D, Haverkamp C, Lapp T, Eberwein P, Reinhard T et al (2018) Influence of postoperative intraocular pressure on graft detachment after descemet membrane endothelial keratoplasty. Cornea 37(11):1347–1350

    Article  PubMed  Google Scholar 

  22. Schrittenlocher S, Schaub F, Hos D, Siebelmann S, Cursiefen C, Bachmann B (2018) Evolution of consecutive descemet membrane endothelial keratoplasty outcomes throughout a 5-year period performed by two experienced surgeons. Am J Ophthalmol 190:171–178

    Article  PubMed  Google Scholar 

  23. Oellerich S, Baydoun L, Peraza-Nieves J, Ilyas A, Frank L, Binder PS et al (2017) Multicenter study of 6-month clinical outcomes after descemet membrane endothelial keratoplasty. Cornea 36(12):1467–1476

    Article  PubMed  Google Scholar 

  24. Hayashi T, Iliasian RM, Matthaei M, Schrittenlocher S, Masumoto H, Tanabe M et al (2022) Transferability of an artificial intelligence algorithm predicting rebubblings after descemet membrane endothelial keratoplasty. Cornea 2:225

    Google Scholar 

  25. Muijzer MB, Noordmans HJ, Delbeke H, Dickman MM, Nuijts RMMA, Dunker S et al (2020) Establishing a biomarker for the prediction of short-term graft detachment after descemet membrane endothelial keratoplasty. Cornea 3:788

    Google Scholar 

  26. Debellemanière G, Guilbert E, Courtin R, Panthier C, Sabatier P, Gatinel D et al (2017) Impact of surgical learning curve in descemet membrane endothelial keratoplasty on visual acuity gain. Cornea 36(1):1–6

    Article  PubMed  Google Scholar 

  27. Dapena I, Moutsouris K, Droutsas K, Ham L, van Dijk K, Melles GRJ (2011) Standardized no-touch technique for descemet membrane endothelial keratoplasty. Arch Ophthalmol 129(1):88–94

    Article  PubMed  Google Scholar 

  28. Dapena I, Ham L, Droutsas K, van Dijk K, Moutsouris K, Melles GRJ (2011) Learning curve in descemet’s membrane endothelial keratoplasty. Ophthalmology 118(11):2147–2154

    Article  PubMed  Google Scholar 

  29. Ang M, Wilkins MR, Mehta JS, Tan D (2016) Descemet membrane endothelial keratoplasty. Br J Ophthalmol 100(1):15–21

    Article  PubMed  Google Scholar 

  30. Bucher F, Hos D, Müller-Schwefe S, Steven P, Cursiefen C, Heindl LM (2015) Spontaneous long-term course of persistent peripheral graft detachments after descemet’s membrane endothelial keratoplasty. Br J Ophthalmol 99(6):768–772

    Article  PubMed  Google Scholar 

  31. Gorovoy MS (2014) DMEK complications. Cornea 33(1):101–4

    Article  PubMed  Google Scholar 

  32. Laaser K, Bachmann BO, Horn FK, Cursiefen C, Kruse FE (2012) Descemet membrane endothelial keratoplasty combined with phacoemulsification and intraocular lens implantation: advanced triple procedure. Am J Ophthalmol 154(1):47-55.e2

    Article  CAS  PubMed  Google Scholar 

  33. Dirisamer M, Dapena I, Ham L, van Dijk K, Oganes O, Frank LE et al (2011) Patterns of corneal endothelialization and corneal clearance after descemet membrane endothelial keratoplasty for fuchs endothelial dystrophy. Am J Ophthalmol 152(4):543-555.e1

    Article  PubMed  Google Scholar 

  34. Feng MT, Price MO, Miller JM, Price FW (2014) Air reinjection and endothelial cell density in Descemet membrane endothelial keratoplasty: five-year follow-up. J Cataract Refractive Surg 40(7):1116–21

    Article  Google Scholar 

  35. López-Miguel A, Sanchidrián M, Fernández I, Holgueras A, Maldonado MJ (2017) Comparison of specular microscopy and ultrasound pachymetry before and after cataract surgery. Graefes Arch Clin Exp Ophthalmol 255(2):387–392

    Article  PubMed  Google Scholar 

  36. Lavy I, Liarakos VS, Verdijk RM, Parker J, Müller TM, Bruinsma M et al (2017) Outcome and histopathology of secondary penetrating keratoplasty graft failure managed by descemet membrane endothelial keratoplasty. Cornea 36(7):777–84

    Article  PubMed  Google Scholar 

  37. Dapena I, Yeh RY, Baydoun L, Cabrerizo J, van Dijk K, Ham L et al (2013) Potential causes of incomplete visual rehabilitation at 6 months postoperative after descemet membrane endothelial keratoplasty. Am J Ophthalmol 156(4):780-788.e1

    Article  PubMed  Google Scholar 

  38. Abdelmassih Y, Dubrulle P, Sitbon C, El-Khoury S, Guindolet D, Doan S et al (2019) Therapeutic challenges and prognosis of descemetʼs membrane endothelial keratoplasty in herpes simplex eye disease. Cornea. 38(5):553–8

    Article  PubMed  Google Scholar 

  39. Siebelmann S, Lopez Ramos S, Scholz P, Matthaei M, Schrittenlocher S, Heindl LM et al (2018) Graft detachment pattern after descemet membrane endothelial keratoplasty comparing air versus 20% SF6 tamponade. Cornea 37(7):834–9

    Article  PubMed  Google Scholar 

  40. Chaurasia S, Price FW, Gunderson L, Price MO (2014) Descemet’s membrane endothelial keratoplasty. Ophthalmology 121(2):454–458

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

Other Acknowledgments such as Statisticians, Medical Writers, Expert contributions: Dr Guindolet and Dr Disegni contributed equally as co-first authors. Damien Guindolet performed the statistical data analysis. We would like to thank Dr Hélène Rouger for her help to collect data.

Funding

None.

Author information

Author notes

  1. Damien Guindolet and Hugo Disegni have contributed equally.

Authors and Affiliations

  1. Ophthalmology Department, Rothschild Foundation Hospital, 25-29 Rue Manin, 75019, Paris, France

    Damien Guindolet, Hugo Disegni, Gilles C. Martin, Georges Azar, Samuel Hardy, Isabelle Cochereau & Eric E. Gabison

  2. Ophthalmology Department, Bichat Claude-Bernard Hospital, Paris, France

    Isabelle Cochereau & Eric E. Gabison

  3. Université de Paris, Paris, France

    Isabelle Cochereau & Eric E. Gabison

Authors
  1. Damien Guindolet
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Hugo Disegni
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Gilles C. Martin
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Georges Azar
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Samuel Hardy
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Isabelle Cochereau
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Eric E. Gabison
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

DG, SH and HD collected the data. DG, GCM, SH, IC and EEG analysed the data. DG performed statistical analysis. DG prepared figure 1. DG, HD, GA, SH, EEG wrote the manuscript text. All authors reviewed the manuscript and approved the version to be published.

Corresponding author

Correspondence to Eric E. Gabison.

Ethics declarations

Competing interests

The authors declare no competing interests.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Guindolet, D., Disegni, H., Martin, G.C. et al. Predictive factors of graft detachment and rebubbling after descemet membrane endothelial keratoplasty. Int Ophthalmol 43, 1511–1521 (2023). https://doi.org/10.1007/s10792-022-02547-4

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10792-022-02547-4

Keywords

Search

Navigation