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The Cologne rebubbling study: a reappraisal of 624 rebubblings after Descemet membrane endothelial keratoplasty
  1. Sebastian Siebelmann1,
  2. Katharina Kolb1,
  3. Paula Scholz1,
  4. Mario Matthaei1,
  5. Jeremy Franklin2,
  6. Alexander Händel1,
  7. Silvia Schrittenlocher1,
  8. Takahiko Hayashi1,
  9. Jose L Guell3,
  10. Björn Bachmann1,
  11. Claus Cursiefen1
  1. 1 Department of Ophthalmology, Uniklinik Köln, Koln, Germany
  2. 2 Institute of Medical Statistics and Bioinformatics, Uniklinik Köln, Koln, Germany
  3. 3 Instituto de microcirugia ocular, Barcelona, Spain
  1. Correspondence to Sebastian Siebelmann, Department of Ophthalmology, University of Cologne, Cologne, Germany; Sebastian.Siebelmann{at}


Background/Aims To analyse graft detachments prior to rebubbling, the influence of rebubbling on the postoperative outcome after Descemet membrane endothelial keratoplasty (DMEK) and the need for rebubbling on the contralateral eye.

Methods In this retrospective cohort study, out of 1541 DMEKs, optical coherence tomography scans and clinical records of 499 eyes undergoing rebubbling after DMEK at the University Hospital of Cologne, Cologne, Germany, were examined. Main Outcome measures were (a) number, localisation and size of graft detachments; (b) influence of rebubbling/s on postoperative outcome after 12 months; and (c) rebubbling risk of the contralateral eye after DMEK.

Results Mean number of detachment areas was 2.02±0.9. Mean lateral diameter of all detachments was 4534.76±1920.83 μm. Mean axial diameter was 382.53±282.02 μm. Detachments were equally distributed over all regions of the cornea. Best spectacle corrected visual acuity ( BSCVA) after 12 months was 0.197±0.23 logarithm of the minimum angle of resolution, endothelial cell density (ECD) was 1575.21±397.71 cells/mm2 and mean central corneal thickness (CCT) was 566.37±68.11 μm. BSCVA, CCT, ECD or endothelial cell loss of all rebubbled patients were not influenced by the number of rebubblings or the time between DMEK and rebubbling. Of the rebubbled patients, which received a DMEK subsequently on the other eye, 193 (58.8%) also received a rebubbling, which was significantly higher, when compared to the overall rebubbling rate of 32.3% (p=0.000).

Conclusions The overall number of rebubblings has no influence on the postoperative outcome after DMEK, if a rebubbling becomes necessary. Patients who received a rebubbling on one eye have an elevated risk for a rebubbling on the fellow eye.

  • Cornea
  • Imaging
  • Treatment Surgery

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  • Contributors Planning: SS, KK. Conduct: SS, KK, PS, MM, AH, JF, SSC, TH, BB, CC. Reporting: SS, MM, KK, CC, BB, JLG. All the authors provided significant contribution to planning, conduct and reporting of this study.

  • Funding This study was supported by DFG FOR 2240 ‘(Lymph) Angiogenesis and Cellular Immunity in Inflammatory Diseases of the Eye’ (SS, CC;; EU COST BM 1302 ‘Joining Forces in Corneal Regeneration’ (CC, SS); EU STRONG FP7 (CC); EU EFRE NRW (BB, SS); and EU Horizon 2020 Arrest Blindness (CC).

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available upon reasonable request.

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