Feasibility Of Dmek Surgery Without Hospital Overnight Admission During Covid-19 Era

To evaluate incidence of postoperative detachments and complications of DMEK surgery with home discharge on the day of surgery compared to hospital overnight admission

Department of Ophthalmology, St. Paul’s Eye Unit, Royal Liverpool University Hospital, Liverpool, United Kingdom

Retrospective analysis of all patients who underwent DMEK surgery from March 2020 to September 2021. Demographics and surgical data were collected from electronic patients’ records. Intraoperative complications included bleeding, fibrin release, increased vitreous pressure and anterior chamber shallowing. Postoperative complications included air bubble dislocation behind the iris and upside-down grafts. DMEK rebubblings were analyzed separately. Impact of hospital overnight admission versus home discharge after surgery was evaluated. Mann-Withney U test and Fisher’s exact test were conducted as well as generalized linear model (GLM) for recipient age, admission type, intra- and post-operative complications and triple procedure.

73 patients with a mean age of 68.4±15.5 years (55% females) were included in the study (admission vs home, all p>0.25). Reason for surgery was Fuchs dystrophy in 72%, bullous keratopathy in 20% and failed graft in 8% (admission vs home, p=0.756). Triple procedure was performed in 59% of cases (admission vs home, p=0.643). Intraoperative complications occurred in 13.8% of cases (admission vs home, 15% and 12%; p=0.654) and postoperative complications in 6.8% (admission vs home, 10% and 3%; p=0.217). Rate of DMEK graft rebubbling was 36.1% (admission vs home, 36.8% and 35.3%; p=0.891). GLM showed no role of admission type on DMEK rebubbling (p=0.478) while intra-/postoperative complications and triple procedure were all significant (p<0.05).

Our results showed that home discharge on the day of DMEK surgery is a feasible option with no significant increase in the rate of postoperative rebubbling. We acknowledge that more complex surgeries were prioritized during the COVID-19 pandemic and more complex cases might have had higher chances of being admitted in hospital overnight. However, only factors independent from admission type resulted in increasing chances of postoperative DMEK detachment requiring rebubbling. Therefore, in challenging situations such as the COVID-19 era where hospitalization for ophthalmic surgery may not be a priority, discharging DMEK patients 2-3 hours after surgery can be a feasible option with no overall increase in complication rates.