Impact of 10% SF₆ Gas Compared to 100% Air Tamponade in Descemet’s Membrane Endothelial Keratoplasty

ABSTRACT

Purpose: To compare the clinical outcomes following Descemet’s membrane endothelial keratoplasty (DMEK) with 100% air tamponade versus 10% sulfur hexafluoride (SF₆) tamponade.

Methods: Retrospective analysis of 108 consecutive DMEK cases subdivided by anterior chamber tamponade with 54 eyes receiving 10% SF₆ and 54 eyes receiving 100% air injection. A post-hoc matched analysis revealed no statistically significant differences between the groups. The main outcome measurements were the complication rate, including intra- and postoperative complications and graft detachment rate requiring re-bubbling. Clinical outcome included best-corrected visual acuity (BCVA), endothelial cell count (ECC), and central corneal thickness (CCT) measured 1, 3, and 6 months after DMEK surgery.

Results: The graft detachment rate with consecutive re-bubbling was 18.5% in the air group and 22.2% in the SF₆ group (p = 0.2). Remaining small peripheral graft detachments with a clear cornea occurred more often in the 100% air group (air: 22.2%; 12/54, 6/12 inferior compared to SF₆: 7.4%; 4/54, 2/4 inferior; p = 0.06). The primary graft failure rate was comparable between the two groups. No complete graft detachment occurred. Outcome results for BCVA, ECC, and CCT at all follow-up time points were comparable between the two groups.

Conclusion: The clinical outcomes (including re-bubbling rate, primary graft failure rate, and endothelial cell loss) were comparable with 100% air versus 10% SF₆ tamponade, whereas other studies suggest that a higher SF₆ concentration (20%) may result in a lower re-bubbling rate.

KEYWORDS:

• DMEK
• sulfur hexafluoride
• anterior chamber tamponade
• re-bubbling

Informed consent

For this type of study, formal consent is not required.

Declaration of interest

Prof. Peter Szurman has a patent for a device for preparing and introducing a transplant or an implant into a living body, in particular for ophthalmological interventions: EP2533724 B1; WO2012065602 A3

All other authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers’ bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent licensing arrangements), or non-financial interest (such as personal or professional relationships, affiliations, knowledge, or beliefs) in the subject matter or materials discussed in this manuscript.

Additional information

Funding

No funding was received for this research.