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Postoperative supine position after primary Descemet-stripping automated endothelial keratoplasty reduces graft detachment rate

      Abstract

      Objective

      To characterize the association between prolonged supine postoperative positioning of patients undergoing Descemet-stripping automated endothelial keratoplasty (DSAEK) and graft dislocation rate.

      Methods

      In this retrospective cohort study, medical records of patients who underwent uncomplicated DSAEK surgery at Yitzhak Shamir Medical Center between 2010 and 2019 were reviewed. Nursing documentation of patients’ adherence to supine positioning during the postoperative hospitalization period was collected. A patient was considered compliant if he or she was documented as cooperative with supine positioning throughout the first 24 hours.

      Results

      A total of 170 eyes of 138 patients were found eligible. Main indications for surgery were pseudophakic bullous keratopathy (50.6%), previous graft failure (25.9%), and Fuch's endothelial dystrophy (FED; 20.6%). Twelve surgeries were combined with cataract extraction. Postoperative graft detachment occurred in 26 eyes (15.3%) after an average period of 1 day (range, 0–20 days). Compliance with supine positioning was documented in 84.1% (n = 143 patients). Noncompliance rates during the first 24 hours in the detached and nondetached groups were 26.9% (n = 7) and 14.4% (n = 20), respectively; after adjustment for possible confounders, the odds ratio (OR) was 1.44 (p = 0.249). Graft dislocation was observed in 13.3% (19 of 143) and 25.9% (7 of 27) of cooperative and noncooperative patients, respectively (p = 0.17). Subanalysis of 120 eyes with either BPK or FED for which it was the first transplantation demonstrated a protective effect of supine positioning (OR 3.42, confidence interval 1.095–10.700; p = 0.034). Findings for both groups remained unchanged in multivariate analysis.

      Conclusions

      We found a statistically significant protective effect of 24 hours of postoperative supine positioning against graft detachment after DSAEK in eyes with no prior transplantations.

      Résumé

      Objectif

      Décrire l'association entre la position allongée sur le dos prolongée en période postopératoire et le taux de déplacement du greffon chez des patients qui ont subi une kératoplastie endothéliale automatisée de la membrane de Descemet (DSAEK).

      Méthodes

      Dans le cadre de cette étude rétrospective de cohortes, on a examiné les dossiers médicaux de patients qui ont subi une DSAEK sans complication au Centre médical Yitzhak Shamir entre 2010 et 2019. On a consulté les notes du personnel infirmier en ce qui a trait au maintien de la position allongée pendant la période postopératoire à l'hôpital. Les patients qui étaient restés allongés pendant les 24 premières heures après l'intervention ont été considérés comme ayant respecté les exigences postopératoires.

      Résultats

      Au total, 170 yeux de 138 patients ont été jugés admissibles. Au nombre des principales indications de la chirurgie, citons la kératopathie bulleuse du pseudophaque (50,6 %), l’échec antérieur de la greffe (25,9 %) et la dystrophie endothéliale de Fuchs (FED, pour Fuch's endothelial dystrophy; 20,6 %). Dans 12 cas, la chirurgie a été jumelée à l'extraction d'une cataracte. Il s'est produit un décollement postopératoire du greffon dans 26 yeux (15,3 %) après une période moyenne de 1 jour (fourchette : 0–20 jours). Le maintien de la position allongée a été documenté chez 84,1 % des patients (n = 143). Le taux de non-respect de cette exigence pendant les 24 premières heures en présence et en l'absence d'un décollement du greffon se chiffrait à 26,9 % (n = 7) et à 14,4 % (n = 20), respectivement; après ajustement pour tenir compte d’éventuelles variables de confusion, le rapport de cotes (RC) était de 1,44 (p = 0,249). Il s'est produit un déplacement du greffon chez 13,3 % (19 sur 143) et chez 25,9 % (7 sur 27) des patients, selon que le patient a respecté ou non l'exigence postopératoire de rester en position allongée, respectivement (p = 0,17). Selon une sous-analyse de 120 yeux qui présentaient une kératopathie bulleuse du pseudophake ou une FED et qui en étaient à leur première greffe, on a constaté un effet protecteur de la position allongée (RC : 3,42; intervalle de confiance : 1,095–10,700; p = 0,034). Selon l'analyse multivariée, les résultats sont demeurés les mêmes dans les 2 groupes.

      Conclusions

      Le maintien de la position allongée sur le dos pendant 24 heures après la chirurgie a eu un effet protecteur statistiquement significatif contre le décollement du greffon après une DSAEK dans des yeux qui en étaient à leur première greffe.
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