Re-bubbling at slit lamp may be safer than with surgical scope
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Re-bubbling a Descemet’s membrane endothelial keratoplasty graft using an in-office slit lamp may be safer than using a surgical scope, according to a presentation at the virtual American Academy of Ophthalmology annual meeting.
“We know that the re-bubble rate after DMEK is higher than that after DSAEK, and some surgeons fear this will take away from their efficiency during their busy clinic schedule,” Jeffrey L. Tapley Jr., MD, said.
However, performing re-bubbling at the slit lamp offers better anterior depth perception, an easier procedure for the surgeon and patient, and minimal clinic disruption, Tapley and colleagues said in the presentation.
The authors conducted a retrospective chart review for patients requiring re-bubbling for a DMEK graft detachment. Surgical scope procedures were used from June 2011 through September 2015, and slit lamps were used from September 2015 through February 2020. The team compared complication rates for the procedures conducted by multiple surgeons at a single site.
Surgical scopes were used for a total of 63 re-bubbling procedures in 61 eyes and resulted in two complications. Surgeons used slit lamps to perform 168 re-bubbling procedures in 142 eyes with zero complications.
One complication, bleeding from the iris upon entering the anterior chamber with the cannula, was caused by patient head movement. The other noted complication occurred when air injected into the interface caused a permanent edge flap.
“We know that re-bubbling at a slit lamp is certainly easier, faster and more efficient than re-bubbling at a surgical scope. This study now adds that re-bubbling is not only safe but is likely safer than performing re-bubbling procedures at a surgical scope,” Tapley said.
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Tapley JL Jr., et al. Using an in-office slit lamp to rebubble DMEK grafts: Fast, easy, safe. Presented at: American Academy of Ophthalmology annual meeting; Nov. 13-15, 2020 (virtual meeting).
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