This study objectively evaluated the impact of rebubbling on postoperative corneal clarity and endothelial cell loss (ELD) after DMEK. This was a retrospective analysis of 132 consecutive DMEK cases performed for Fuchs endothelial dystrophy or pseudophakic bullous keratopathy. Patients were categorised into three groups, Group 1 (n-32) had one rebubbling procedure, Group 2a (n= 55) had complete graft attachment after DMEK and Group 2b (n=25) had minor peripheral detachment that affected less than one-third of the graft’s area and did not involve the optical zone. All corneas in group two cleared without need for rebubbling. All DMEKs were preformed using the same standardised technique. All rebubbling procedures were performed under local anaesthesia using air for complete fill initially and an hour later some air was replaced with balanced salt solution leaving the anterior chamber with 50-60% air fill. Patients were then postured according to the location of the graft detachment. Postoperatively, corneal clarity was assessed using Scheimpflug corneal densitometry. Endothelial cell density, central corneal thickness and corneal volume were measured preoperatively and at three, six,12 and 24 months. Central corneal density decreased in all groups from preoperative values, but no statistically significant differences were observed among the three groups at any examination time point. Endothelial cell density at three months was higher in group 2a (1613±503 cells/mm2) than in group 1 (1350±557 cells/mm2; P = 0.033). ECL at 24 months was 56%, 43%, and 53% in groups 1, 2a, and 2b, respectively. Group 2a showed the lowest ECL, central corneal thickness, and corneal volume throughout the study period. The authors concluded that a single rebubbling procedure does not increase the cell density (CD) of the central cornea and results in significantly higher ECL compared with uneventful DMEK with complete graft attachment.

Recovery of corneal clarity after DMEK followed by rebubbling versus uneventful DMEK.
Lazaridis A, Fydanaki Q, Giallouros E, et al.
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Bushra Thajudeen

Singleton Hospital, Swansea, UK.

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