A paracentesis to save time and money with re-bubbling after descemets membrane endothelial keratoplasty

Descemet’s membrane endothelial keratoplasty (DMEK) is becoming more popular among corneal surgeons for management of endothelial diseases. The benefits of endothelial keratoplasties include

lower rate of rejection, rapid visual recovery, and less surgically induced astigmatism.1 The frequently encountered frustration with DMEK is partial graft detachment in the early

postoperative period, which varies in several studies, with one multicentre study reporting the occurrence rate to be as high as 34.6%.2 Typically, partial graft detachments are treated by

bringing the patients back to theatre for a re-bubbling procedure. This results in additional costs of theatre utilisation, surgeon time, and staff time. In this article, we describe the

creation of a paracentesis on 5 o'clock (for right-handed surgeons) or 7 o'clock (for left-handed surgeons) at the limbus with a 15° blade before completing the DMEK procedure in

the operating theatre as illustrated in Figure 1. The creation of this paracentesis can be in addition to or as a part of the required DMEK surgery paracentesis incisions (based on whether

the surgeon is sitting superiorly or temporally). This allows the surgeon to re-bubble the anterior chamber using a simple insulin syringe with a bent needle or a 2 ml syringe with a cannula

on the slit lamp under topical anaesthesia using the right hand after instillation of G. Povidone Iodine 5% during the clinic follow-up. The patient is prescribed topical antibiotics for a

week and topical steroids as per the surgeon’s protocol after the clinic re-bubbling procedure. This paracentesis incision avoids the need for bringing the patient back to the operating

theatre, thus reducing the costs and time. This paracentesis can be used up to 2 weeks postoperatively on the slit lamp. The paracentesis is created at 5 o'clock with the assumption

that the surgeon is right-handed, and can be modified depending on hand dominance (Figure 1). Using this new paracentesis in all our DMEK patients, we have been successful in 100% avoidance

of re-admission to the theatre and cost reductions for re-bubbling procedures. REFERENCES * Nanavaty MA, Wang X, Shortt AJ . Endothelial keratoplasty versus penetrating keratoplasty for

Fuchs endothelial dystrophy. _Cochrane Database Syst Rev_ 2014; (2): CD008420. * Monnereau C, Quilendrino R, Dapena I, Liarakos VS, Alfonso JF, Arnalich-Montiel F _et al_. Multicenter study

of descemet membrane endothelial keratoplasty: first case series of 18 surgeons. _JAMA Ophthalmol_ 2014; 132 (10): 1192–1198. Article  Google Scholar  Download references AUTHOR INFORMATION

AUTHORS AND AFFILIATIONS * Sussex Eye Hospital, Brighton and Sussex University Hospitals NHS Trust, Brighton, UK F M Chew & M A Nanavaty * Brighton & Sussex Medical School,

University of Sussex, Falmer, Brighton, UK K Teeluck & M A Nanavaty Authors * F M Chew View author publications You can also search for this author inPubMed Google Scholar * K Teeluck

View author publications You can also search for this author inPubMed Google Scholar * M A Nanavaty View author publications You can also search for this author inPubMed Google Scholar

CORRESPONDING AUTHOR Correspondence to M A Nanavaty. ETHICS DECLARATIONS COMPETING INTERESTS The authors declare no conflict of interest. RIGHTS AND PERMISSIONS Reprints and permissions

ABOUT THIS ARTICLE CITE THIS ARTICLE Chew, F., Teeluck, K. & Nanavaty, M. A paracentesis to save time and money with re-bubbling after descemets membrane endothelial keratoplasty. _Eye_

32, 238–239 (2018). https://doi.org/10.1038/eye.2017.189 Download citation * Published: 01 September 2017 * Issue Date: February 2018 * DOI: https://doi.org/10.1038/eye.2017.189 SHARE THIS

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