AUTHOR=Kim Chung Young , Yoon Chang Ho , Kim Mee Kum TITLE=Risk factors for early graft detachment requiring rebubbling in Descemet membrane endothelial keratoplasty with imported pre-cut donor tissues JOURNAL=Frontiers in Medicine VOLUME=11 YEAR=2024 URL=https://www.frontiersin.org/journals/medicine/articles/10.3389/fmed.2024.1266049 DOI=10.3389/fmed.2024.1266049 ISSN=2296-858X ABSTRACT=

Graft detachment is a common and significant complication in Descemet membrane endothelial keratoplasty (DMEK). We investigated the risk factors of graft detachment requiring rebubbling after DMEK using imported pre-cut donor tissues. The medical records of 48 patients who underwent DMEK for Fuchs’ endothelial dystrophy (FED) or bullous keratopathy (BK) at Seoul National University Hospital were retrospectively reviewed. Donor, recipient, and surgical factors were evaluated using univariate and multivariate logistic regression models. Graft detachment requiring rebubbling occurred in 17 (32.7%) eyes. The detachment group exhibited older recipient age (p = 0.006), higher prevalence of diabetes (p = 0.001), and a higher proportion of FED (65%, p = 0.003). Notably, the detachment group demonstrated a significantly lower postoperative 2-h intraocular pressure (IOP) (p = 0.002) and a greater proportion of eyes with IOP <20 mmHg (p < 0.001). Older recipient age (OR 1.08, 95% CI 1.02–1.17), diabetes (OR 23.8, 95% CI 2.61–217), FED surgical indication (OR 6.19, 95% CI 1.74–22.0), lower postoperative 2-h IOP (OR 1.21, 95% CI 1.06–1.38), and postoperative 2-h IOP <20 mmHg (OR 14.0, 95% CI 1.64–119) were associated with increased odds of graft detachment. According to multivariate logistic regression, lower postoperative 2-h IOP (OR 1.23, 95% CI 1.02–1.47) and postoperative 2-h IOP <20 mmHg (OR 25.1, 95% CI 1.05–602) increased the risk of graft detachment. Lower postoperative 2-h IOP, particularly below 20 mmHg, may increase the risk of graft detachment, and diabetes in recipients may pose a higher risk of graft detachment after DMEK.