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Rebubbling Techniques for Graft Detachment After Descemet Membrane Endothelial Keratoplasty

机译：Descemet膜内皮角膜移植术后移植物脱离的鼓泡技术

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Purpose:To describe rebubbling techniques in eyes with a visually significant graft detachment after Descemet membrane endothelial keratoplasty (DMEK).Methods:Retrospective observational analysis at a tertiary referral center. A total of 41 eyes (39 patients) received rebubbling: 39 eyes (37 patients) had 1 and 2 eyes had 2 rebubbling procedures. Anterior segment optical coherence tomography and surgical videos were used to determine the best incisional approach for air injection, intraoperative maneuvers, and success rate (graft reattachment) at 1 week postoperatively.Results:Rebubbling was performed on average 26 (21) days (range: 7-92 days) after DMEK. Graft edge visibility and configuration of graft detachment were important parameters for the incisional approach for air injection: the air cannula was introduced in the area of graft attachment (attached area approach) (n = 25) or detachment (detached area approach) (n = 16). After excluding upside-down grafts (n = 3), the rebubbling success rate in total was 87% (33/38 eyes); in the attached area approach, it was 92% (22/24 eyes); and in the detached area approach, it was 79% (11/14). Of 14 eyes that had rebubbling later than 1 month postoperatively, 11 were successful; in 8 eyes, the graft seemed too stiff and/or immobile to allow complete unfolding.Conclusions:Rebubbling is a feasible procedure to manage graft detachment after DMEK if the graft is correctly oriented. Proper preoperative planning may aid in minimizing intraoperative complications and may increase the success rate. Late interventions (>1 month postoperatively) may still produce graft reattachment, but increased graft stiffness and/or fibrosis may complicate complete graft unfolding.
机译：目的：描述在Descemet膜内皮角膜移植术（DMEK）后出现视觉上明显的移植物脱离的眼睛中的重新起泡技术。方法：在三级转诊中心进行回顾性观察分析。总共41眼（39例患者）接受了重新起泡：39眼（37例患者）进行了1次起泡，2眼进行了2次起泡。前段光学相干断层扫描和手术录像被用于确定术后1周进行注气，术中操作和成功率（植骨再植）的最佳切开方法。结果：平均在26（21）天进行鼓泡（范围： DMEK之后的7-92天）。移植物边缘的可见性和移植物脱离的配置是进行空气注射切开术的重要参数：将空气套管引入移植物附着区（附着区方法）（n = 25）或脱离区（分离区方法）（n = 16）。排除上下颠倒的移植物（n = 3）后，重新起泡成功率总计为87％（33/38眼）;在附着区方法中，这一比例为92％（22/24眼）;在独立区域法中，这一比例为79％（11/14）。术后1个月后起泡的14只眼中，有11例成功。在8只眼中，移植物似乎太僵硬和/或无法移动，无法完全展开。结论：如果正确定向移植物，重新起泡是在DMEK后处理移植物脱离的可行方法。正确的术前计划可能有助于最大程度地减少术中并发症，并可能增加成功率。后期干预（术后> 1个月）可能仍会导致移植物重新附着，但移植物刚度和/或纤维化增加可能会使移植物完全展开​​复杂化。

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