In a randomized control investigation of patients with Fuchs dystrophy, maintaining a supine position for 5 days vs 1 day after Descemet membrane endothelial keratoplasty (DMEK) surgery did not appear to have any additional positive impact on surgical outcomes. These findings suggest that prolonged postoperative positioning may not be necessary after DMEK when air is used, though further studies are recommended.
Study Design
This double-masked randomized control trial investigated the influence of supine positioning after DMEK surgery on graft detachment. Eighty-six patients with Fuchs dystrophy who underwent DMEK were randomized to undergo 5 days of supine head positioning (intervention) or 1 day of supine head positioning (control) after surgery. Compliance was measured using a 3-dimensional head sensor. The area and volume of graft detachment were evaluated 2 weeks after surgery along with subjective visual function, the incidence of repeat air injection (rebubbling), and any adverse events.
Outcomes
At postoperative week 2, there were no statistically significant differences in the area or volume of graft detachment or in rebubbling rates between the two groups. Visual function results also were similar. Interestingly, graft detachment at postoperative day 1 was the strongest predictor of 2-week graft detachment, regardless of head positioning after postoperative day 1.
Limitations
This study used air for rebubbling, but previous studies have suggested that the use of SF6 or C3F8 gas (vs air) is associated with lower detachment rates.1,2 Thus, the positive effects of prolonged supine positioning may have diminished more quickly as air dissipated from the anterior chamber.
Clinical Significance
Supine positioning for patients who receive air tamponade does not appear to be beneficial to recovery after DMEK. Knowing this, patients may be able to avoid prolonged supine positioning and the associated back discomfort without compromising surgical outcomes.
Financial Disclosures: Dr. Daniel Choi discloses financial relationships with Glaukos (Lecture Fees/Speakers Bureau) and Kala Pharmaceuticals (Consultant/Advisor).
References:
1 Siebelmann S et al. Cornea. 2018 Jul;37(7):834-839
2 Wiley Z et al. Cornea. 2024(in press):10.1097