Jessica Tong1, Yves Kerdraon1,2

Purpose: Descemet’s stripping endothelial keratoplasty (DSEK) has a mean detachment rate of 14.5% (range 0-82%). Rebubbling is an effective intervention for graft re-apposition to the cornea. Timing of the rebubbling procedure is currently determined by multiple factors, including degree of graft separation, extent of progression, visual acuity and surgeon preference and availability. Our study aims to determine the optimal time to rebubbling of detached DSEK grafts.

Method: Retrospective review of all DSEK grafts performed at Sydney Eye Hospital from 2007-2016, that required rebubbling for post-operative graft detachment. Success was defined as complete graft reattachment and central corneal clarity. The relationship between time to rebubbling and final outcome was assessed using logistic regression analysis. A p-value<0.05 was considered statistically significant.

Results: Of 199 DSEK surgeries, 22 eyes (11.1%) with graft detachment requiring rebubbling were identified. Rebubbling was performed at an average of 16.4 days (range 1-37 days). There were no cases of hypotony. The success rate for eyes that underwent rebubbling at < 6 days was 50% (7/14), compared with rebubbling success at ? 6 days of 62.5% (5/8). The odds of success for eyes treated at < 6 days was 0.4 compared with eyes rebubbled at ? 6 days (95% CI 0.1-2.3, p=0.3), adjusted for tube presence.

Conclusion: Our study demonstrates a trend towards greater likelihood of success for rebubbling performed ? 6 days. Several days may be required for endothelial recovery from initial surgical trauma. Future larger sample size studies would provide further insight and confirmation of these findings.