The effect of successful rebubbling after descemet stripping automated endothelial keratoplasty on endothelial cell counts

Purpose: To examine the effect of successful repositioning/rebubbling of the graft on endothelial cell counts (ECCs) in eyes after Descemet stripping automated endothelial keratoplasty. Methods: This retrospective study reviewed the outcomes of 58 eyes that underwent Descemet stripping automated endothelial keratoplasty. Fifty-one eyes were attached after surgery. Seven were detached and underwent rebubbling with minimal manipulation in 5 and significant manipulation in 2, after which the graft was attached and clear. Visual outcomes and endothelial cell loss at 6 months were compared between eyes that underwent repositioning/rebubbling and those that did not. The following were excluded: 2 eyes that had primary failure, 2 eyes that had rejection, 1 eye that failed to attach after rebubbling, 2 eyes that failed to clear after rebubbling, and 24 eyes that did not have ECC at 6 months. Results: The 2 groups were comparable considering age, preoperative best-corrected visual acuity, surgical variables, combined procedures, donor cell count, and graft size. The mean postoperative spherical equivalent, manifest and topographic astigmatism, uncorrected visual acuity, and best-corrected visual acuity did not differ significantly between the 2 groups at 6 months. Mean pre- and postoperative ECC did not differ significantly between the group that underwent repositioning/rebubbling and the group that did not (preoperative counts 2742 ± 268 vs. 2747 ± 353 and postoperative counts 1590 ± 367 vs. 1746 ± 491, respectively). Endothelial cell loss also did not differ significantly between the 2 groups, although there was a trend to greater cell loss in the reattachment group (-39.4% ± 11.1% vs. -38.3% ± 16.2%, respectively; P = 0.6). Conclusion: Successful reattachment procedure does not seem to cause significant endothelial cell loss.