Predictive factors for re-bubbling after DMEK: focus on the posterior corneal surface

Raphael Kilian; Emanuele Crincoli; Jan Lammer; Clara Rizzo; Emilio Pedrotti; Gerald Schmidinger

doi:10.1007/s00417-024-06383-3

Predictive factors for re-bubbling after DMEK: focus on the posterior corneal surface

Graefes Arch Clin Exp Ophthalmol. 2024 Feb 8. doi: 10.1007/s00417-024-06383-3. Online ahead of print.

Authors

Raphael Kilian¹, Emanuele Crincoli^{2

3}, Jan Lammer⁴, Clara Rizzo¹, Emilio Pedrotti¹, Gerald Schmidinger⁴

Affiliations

¹ Ophthalmic Unit, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy.
² Ophthalmology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS," , Rome, Italy. emanuelecrincoli1@gmail.com.
³ Catholic University of "Sacro Cuore," , Rome, Italy. emanuelecrincoli1@gmail.com.
⁴ Department of Ophthalmology and Optometry, Medical University of Vienna, Vienna, Austria.

PMID: 38326628
DOI: 10.1007/s00417-024-06383-3

Abstract

Purpose: To understand whether the preoperative morphology of the posterior corneal surface influences the rate of re-bubbling after Descemet membrane endothelial keratoplasty (DMEK).

Methods: After retrospectively analyzing the medical records of patients undergoing DMEK, in this multicentric cross-sectional study, we performed a binomial logistic regression analysis to assess significant predictors of re-bubbling and re-transplantation after surgery. Analyzed parameters included the preoperative diagnosis, anterior and posterior surface K1/K2, central corneal thickness, posterior Q value, and other posterior corneal surface parameters evaluated on the elevation maps produced by anterior segment optical coherence tomography. Results were stratified based on the surgeons' experience.

Results: We included 202 eyes of 202 patients with a mean age of 69.5 ± 12.4 years; 154 eyes were operated by a high-volume surgeon and 48 by one with less experience; 48 eyes (23.8%) underwent [Formula: see text] 1 re-bubbling and 14(6.9%) [Formula: see text] 1 re-transplantation. The presence of positive/less-negative posterior corneal irregularities and irregularities with greater absolute height had a significantly higher risk of re-bubbling in both the expert and less expert group (OR = 2.85 and 1.42, OR = 3.22 and 3.01, respectively, p < 0.05), whereas more negative posterior K1 and K2 were significant risk factors only in the former group (OR = 0.67 and 0.55, respectively, p < 0.05). Endothelial decompensation other than Fuchs and pseudophakic bullous keratopathy, more negative posterior Q values and smaller distances between center, and the highest/lowest posterior corneal surface irregularity correlated with an increased risk of graft failure (OR 1.23, 1.21, and 1.29, respectively, p < 0.05).

Conclusion: Posterior corneal surface morphology significantly influences the risk of re-bubbling after DMEK.

Keywords: Biomarker; Descemet membrane endothelial keratoplasty; Re-bubbling; Risk factor.