Factors Associated With Early Graft Detachment in Primary Descemet Membrane Endothelial Keratoplasty

Purpose: To evaluate the risk factors for early graft detachment in Descemet membrane endothelial keratoplasty (DMEK). Design: Case-control study. Methods: PARTICIPANTS: A total of 173 donor corneas and 173 eyes of the patients following DMEK or DMEK in combination with phacoemulsification and intraocular lens implantation were included. INTERVENTION: Pre-stripped DMEK grafts were transplanted using pull-through technique. At the end of surgery, the anterior chamber was filled with air, which was removed 3 hours later only if pupillary block was suspected. Rebubbling was performed in all cases with graft detachment, independently of its extension, as documented by means of anterior segment optical coherence tomography. The donor characteristics were collected from the eye bank database and matched with the recipient database. MAIN OUTCOME MEASURES: Donor and recipient characteristics affecting graft detachment using univariate and multivariate analysis. Results: The combination of DMEK with cataract removal and IOL implantation (odds ratio [OR] = 5.31, 95% confidence interval [CI] 2.03-13.86, P <.002) and air fill of ≤75% of anterior chamber height at 2-3 hours postoperatively (OR = 2.66, 95% CI 1.12-6.34, P =.027) were found to be independent risk factors for postoperative graft detachment. Conclusions: Cataract removal at the time of DMEK is a risk factor for early graft detachment and therefore sequential surgery may be preferred over combined surgery in an attempt at minimizing rebubbling. Air level in the anterior chamber should be monitored and maintained above 75% in the early hours following surgery.