Rebubbling and Graft Detachment in Pre-Descemet Endothelial Keratoplasty: A Prospective Study

To report the graft detachment and rebubbling rate of pre-Descemet endothelial keratoplasty (PDEK) in patients with Fuch dystrophy and pseudophakic bullous keratopathy.

In this prospective interventional study of 131 eyes (131 patients), the main-outcome measures were visual acuity, graft detachment and rebubbling rate, pachymetry, and endothelial cell count (ECD) loss.

The mean age of graft recipients was 64.5 ± 12.3 years(range 21-87 years); the mean donor age was 25.1 ± 8.7 years(range 10-70 years); and mean graft size was 7.5 ± 0.4 mm. Four eyes (3%) experienced partial graft detachment. Inferotemporal detachment was detected in 2 eyes, inferior in 1 eye, and central detachment in 1 eye. Two cases with graft detachment had no air bubble in the anterior chamber and 2 cases had less than 20% air in anterior chamber on the first postoperative day (POD). The graft detachment was detected on first POD in 2 cases, on second POD in 1 case and on third POD in 1 case. The mean ECD loss was 22.3%, whereas the ECD loss for eyes that underwent rebubbling was 24.8%. There was significant improvement in visual acuity (P < 0.001). Postoperative best-corrected visual acuity was not dependent on donor age, donor specular count, or PDEK graft size. There was no significant correlation between ECD loss and postoperative best-corrected visual acuity (P = 0.524). The mean preoperative central corneal thickness was 758 ± 152.1 μm, whereas the mean postoperative central corneal thickness was 541.3 ± 90.8 μm (P = 0.000). No incidence of graft failure or rejection was observed during 18 months of follow-up.

PDEK offers satisfactory visual outcomes and has a favorable complication profile with lower rate of graft detachment and rebubbling rate of 3%.