'Posture-Less' DMEK: Is Posturing After Descemet Membrane Endothelial Keratoplasty Actually Necessary?

circle PURPOSE: To evaluate the clinical results of Descemet membrane endothelial keratoplasty (DMEK) without any intraoperative or postoperative posturing. circle DESIGN: Retrospective, noncomparative, and interventional case series. circle METHODS: One hundred thirty-four (134) consecutive eyes of 101 patients requiring DMEK for any cause of endothelial failure were included. Descemet membrane endothelial keratoplasty was performed with an intraop-erative inferior PI. After unscrolling and centration of the graft, the anterior chamber was near completely filled with 20% SF6. After filling the eye with gas there was no intraoperative tamponade time, and patients did not pos-ture postoperatively. Main outcome measures were: graft detachment rate, rebubbling rate, primary and secondary failure rates, rejection rate, intraoperative and postoperative complications, and visual acuity 3 and 12 months after surgery. circle RESULTS: Five of 134 (3.7%) developed graft detach-ment greater than one-third of the graft area, and 19 of 134 (14.2%) developed graft detachment less than one-third of the graft area. A rebubble procedure was performed in 19 of 134 (14.2%); of those, the av-erage number of rebubbling procedures performed was 1.13 (range, 1-2). Primary failure occurred in 6 of 134 (4.5%).Twelve-month graft survival occurred in 122 of 134 eyes (91.0%), with secondary failure within the first 12 months accounting for failure of 6 of 134 (4.5%). Nine of 134 (6.7%) cases had a recorded episode of en-dothelial rejection. The average time for rejection episode was 9.5 months (range, 1-20 months) after surgery. circle CONCLUSIONS: A total of 134 `posture-less' DMEKs did not suffer very high rates of graft detachment, rebub-bling, or other postoperative complications, even with im-mediate erect posturing after surgery. (Am J Ophthal-mol 2022;240: 23-29. (c) 2022 Elsevier Inc. All rights reserved.)