Purpose:

To describe re-bubbling techniques and clinical outcome in eyes with visually significant graft detachment after Descemet membrane endothelial keratoplasty (DMEK).

Methods:

Out of 760 consecutive DMEK surgeries, 41 eyes (39 patients) received re-bubbling. Anterior segment optical coherence tomography and surgical videos were used to determine the best incisional approach for air injection, intraoperative maneuvers, and the success rate (graft re-attachment) at one week postoperatively. Main outcome measures: Best corrected visual acuity (BCVA), endothelial cell density (ECD) and pachymetry at 6 months postoperatively were compared to a matched control group with uneventful primary DMEK.

Results:

Re-bubbling was performed on average 26 (±21) days after DMEK. Graft-edge visibility and detachment type determined the area of air injection. Excluding upside-down grafts (n=3) resulted in a success rate of 87% (33/38 eyes). BCVA and pachymetry did not differ (P>0.05), whereas ECD decrease was higher in re-bubbled eyes compared to controls (54% vs. 35%, P<0.05).>

Conclusions:

Re-bubbling is a feasible procedure to manage graft detachment after DMEK. Re-bubbling may give similar visual outcomes as in uncomplicated DMEK, when performed within the first postoperative weeks. Re-bubbled eyes may show lower ECD, which may be attributed to additional air bubble trauma and/or selection bias through more extensive manipulation during initial DMEK or higher risk of detachment in complicated eyes.