RT Journal Article SR Electronic T1 Rebubbling and graft failure in Descemet membrane endothelial keratoplasty: a prospective Dutch registry study JF British Journal of Ophthalmology JO Br J Ophthalmol FD BMJ Publishing Group Ltd. SP 17 OP 23 DO 10.1136/bjophthalmol-2020-317041 VO 107 IS 1 A1 Dunker, Suryan A1 Winkens, Bjorn A1 van den Biggelaar, Frank A1 Nuijts, Rudy A1 Kruit, Pieter Jan A1 Dickman, Mor A1 YR 2023 UL http://bjo.bmj.com/content/107/1/17.abstract AB Aims To identify risk factors for rebubbling, and early graft failure after Descemet membrane endothelial keratoplasty (DMEK).Methods In this prospective registry study, all consecutive DMEK procedures registered in the Netherlands Organ Transplant Registry were assessed (n=752). Univariable and multivariable analysis was performed using logistic regression. The effect of rebubbling on endothelial cell density was analysed using a linear mixed model.Results 144 of 752 (19%) eyes underwent rebubbling. Rebubbling was successful in 101 eyes (70%). In eyes that underwent rebubbling, the graft failure rate was significantly higher than eyes that did not undergo rebubbling (30% vs 9%, respectively; OR: 4.28, 95% CI 2.72 to 6.73, p<0.001). In multivariable analysis, independent risk factors for rebubbling were surgical complication (OR: 2.28, 95% CI 1.20 to 4.33, p=0.012) and older recipient age (OR: 1.04 (per increase of 1 year), 95% CI 1.01 to 1.07, p=0.003). Risk factors for developing graft failure within 3 months were transplant before 2016 (OR: 3.32, 95% CI 1.87 to 5.90, p<0.001), and surgical complication (OR: 2.93, 95% CI 1.42 to 6.04, p=0.004). Throughout the study period, rebubbling and early graft failure were inversely related. Eyes that underwent rebubbling showed significantly lower endothelial cell densities at 3, 6 and 12 months compared with eyes that did not undergo rebubbling (all p<0.001).Conclusions This Dutch registry study identified independent risk factors for DMEK graft detachment leading to rebubbling, namely recipient age and surgical complication, and early graft failure, namely transplantation before 2016 and surgical complication. Rebubbling was associated with significantly higher endothelial cell loss in the first year after surgery.No data are available. The data that support the findings of this study are available from Netherlands Organ Transplant Registry but restrictions apply to the availability of these data, which were used under license for the current study, and so are not publicly available.