Rebubbling of detached descemet membrane endothelial grafts at the slit lamp with 50% air fill after PI-less DMEK during COVID-19 era.

Abstract

To describe the effective use of only 50% air fill of the anterior chamber for rebubbling partially detached Descemet Membrane Endothelial Keratoplasty (DMEK) grafts at the slit lamp at a time of restricted operating theatre access during the COVID-19 pandemic. We present two cases of patients who underwent rebubbling of a partially detached DMEK grafts at the slit lamp following DMEK surgery without peripheral iridotomy. The rebubbling was performed with a 27-gauge needle attached to a 1ml syringe and the patients seated at the slit lamp. Air was injected into the anterior chamber until a 50% air fill was achieved. The patients were instructed to lie supine for 30 min in clinic and the remainder of the day at home. We performed two rebubbling procedures at the slit lamp using the standard needle and syringe. Both cases achieved 50% air fills without any complications. At 3 days post-procedure the air bubble had resolved and the graft appeared attached centrally and at day 14 post-procedure the two patients had a clear and attached corneal graft with corrected visual acuity of 6/7.5 and 6/9, respectively. Rebubbling of detached DMEK grafts at the slit lamp with 50% air fill in the anterior chamber is a relatively simple and effective procedure. This provides an alternative approach for managing the complication of partially detached DMEK grafts in the era of COVID-19 with limited operating theatre access and avoids the risk of complications such as pupillary block in 'PI-less' DMEK.