Postoperative Handling and Management of Graft Detachments

Endothelial keratoplasty (EK), in particular Descemet membrane endothelial keratoplasty (DMEK), has revolutionized modern endothelial keratoplasty procedures with its unprecedented clinical outcomes and lower complication rates [1–9]. With the introduction of EK, however, graft detachment has emerged as a new complication. It is the most common complication after DMEK and “feared” by novel surgeons especially when adopting the DMEK technique [2, 10–15]. Higher detachment rates are noted for DMEK, while techniques that utilize thicker endothelial grafts, such as (Ultrathin-) Descemet membrane (automated) endothelial keratoplasty (DS(A)EK) or Pre-Descemet’s endothelial keratoplasty (PDEK) report lower detachment rates [5, 16–18]. Main uncertainties in dealing with DMEK detachments are: (1) how to avoid them, (2) which ones to treat, and (3) when is the best timing for treatment?