Influence of Intraoperative Air Tamponade Time on Graft Adherence in Descemet Membrane Endothelial Keratoplasty

Purpose: To study the influence of different intraoperative air tamponade times on graft adherence after Descemet membrane endothelial keratoplasty (DMEK). Methods: In this interventional case series, we evaluated 117 eyes with Fuchs endothelial corneal dystrophy (FECD) that underwent DMEK using intraoperative air tamponade times of 60 minutes (group I; n = 39), 45 minutes (group II; n = 39), or 30 minutes (group III; n = 39). At 1 and 6 months postoperatively, graft adherence status, endothelial cell density, central pachymetry, and postoperative complications were recorded. Results: At 1 month, 19 of the 117 eyes (16.2%) showed a clinically significant detachment (>1/3 of the graft surface area and affecting visual axis): 6 eyes in group I (15.4%), 5 eyes in group II (12.8%), and 8 eyes in group III (20.5%) (P = 0.82). A minor detachment (<1/3 of the graft surface area and not affecting visual axis) was observed in 6 eyes in group I (15.4%), in 7 eyes in group II (17.9%), and in 4 eyes in group III (10.3%) (P = 0.82). The overall rebubbling rate was 11%, with no difference among the groups (P = 0.07). Mean endothelial cell density decrease at 6 months was 41% (+/- 17%) (P = 0.56), whereas mean central pachymetry decreased by 23 (+/- 10) % (P = 0.77), with no differences between the groups. Conclusions: The incidence of graft detachment after DMEK for FECD did not differ between the eyes that had a 60-, 45-, or 30-minute intraoperative air tamponade. Reducing the intraoperative air tamponade time to 30 minutes may be considered for DMEK in eyes with uncomplicated FECD.