Posturing After Descemet Membrane Endothelial Keratoplasty (DMEK): Essential or Unnecessary Burden?

Background: This study aims to evaluate the effect of postoperative posturing on graft detachment and rebubbling rates following Descemet Membrane Endothelial Keratoplasty (DMEK). Methods: This was an interventional comparative cohort study, assessing patients with and without posturing. All consecutive eyes requiring DMEK or phaco-DMEK were included in two chronological cohorts. The first cohort received strict 48 h postoperative posturing instructions, while the subsequent cohort received no posturing advice. Primary outcomes were graft detachment and rebubbling rates. Secondary outcomes were other adverse events and 6 months functionality. Results: A total of 119 eyes were included: 29 eyes in the posturing cohort (PC) and 90 eyes in the no-posturing cohort (no-PC). Forty-five eyes developed a graft detachment and rebubbling was performed in 38 eyes (37.8% resp. 31.9%). There was no significant difference in detachments (37.9% PC vs. 37.8% no-PC, p = 0.99) or rebubbling (31.0% PC vs. 32.2% no-PC, p = 0.91) between cohorts. Graft failure occurred twice in both cohorts (6.9% PC vs. 2.2% no-PC, p = 0.23). Conclusions: Abstaining from postoperative posturing did not impact the clinical outcomes of DMEK surgery. Eliminating posturing could reduce patient discomfort, health risks, and broaden eligibility for endothelial keratoplasty.