Combining DMEK with cataract surgery may increase graft detachment risk

This retrospective analysis examined risk factors for early graft detachment in Descemet membrane endothelial keratoplasty (DMEK).

Study design

The authors examined 173 eyes that underwent DMEK at a single institution. They identified 59 eyes with any level of graft detachment, and examined the demographic, co-morbidity, donor, and surgical parameters of these eyes.

Outcomes

The authors identified 2 key findings. First, eyes undergoing triple procedures (cataract extraction, intraocular lens implant and DMEK) had a higher risk of detachment than eyes undergoing DMEK alone (OR 5.31; P<0.002). Second, eyes with less than 75% of residual air bubble at 2-3 hours postoperatively were more likely to experience graft detachment (OR 2.66; P=0.27).

Limitations

Aside from its retrospective nature, this study only examines the rate of detachment. While it may be considered a strength, it is also limiting in that the clinical significance of these detachments is not clear. The size and location of the detachments are not provided, which would have been helpful. In addition, the authors do not clearly express whether the eyes undergoing the triple procedure were also more likely to have smaller immediate postoperative air bubbles.

Clinical significance

The authors suggest that sequential cataract extraction and DMEK surgery may lower rates of graft detachment. They also are proponents of maintaining a maximal air bubble for the first day following surgery. Further study is needed to clarify the clinical significance of these findings.