Maxi-DMEK and Maxi-Rebubbling: Early Experience With New Concepts to Ensure DMEK Graft Adhesion in Unicameral Eyes or After Glaucoma Filtration Surgery.

PURPOSE: To evaluate simultaneous anterior and posterior chamber gas tamponade to improve Descemet membrane endothelial keratoplasty (DMEK) graft attachment in unicameral eyes such as in aniridia or with a history of pars plana vitrectomy (PPV) or glaucoma surgery.

METHODS

This retrospective case series included 10 procedures in 9 complex eyes, many rendered unicameral from prior PPV or glaucoma surgery. Patients underwent DMEK (n = 7) or rebubbling (n = 3) with simultaneous anterior and posterior gas tamponade via 23-G PPV using 20% sulfur hexafluoride (SF6). Main outcomes were graft attachment, central corneal thickness (CCT), best spectacle-corrected visual acuity (BSCVA), and intraocular pressure (IOP) at 3 months.

RESULTS

All 10 grafts were attached on day 1; 2 (20%) required subsequent rebubbling. At 3 months, mean CCT significantly decreased from 723.7 ± 166.2 μm to 533.9 ± 84.8 μm (P = 0.019). Mean BSCVA improved from 1.21 ± 0.85 to 0.93 ± 0.89 logMAR (P = 0.207), limited by comorbidities. Mean IOP was stable, changing from 16.9 ± 7.2 mm Hg preoperatively to 19.2 ± 12.5 mm Hg (P = 0.858). Two cases required increased glaucoma therapy; 1 graft failure was successfully managed with a repeat procedure.

CONCLUSIONS

Simultaneous anterior and posterior chamber gas tamponade seems to be an effective technique for achieving DMEK graft attachment in challenging unicameral eyes after vitrectomy or glaucoma surgery. This approach may help overcome poor graft adhesion because of postoperative gas dislocation common in these conditions but necessitates combined corneal and vitreoretinal surgical expertise.