*Correspondence, Ahmad Shakeel: drshakeel333@gmail.com

Purpose To evaluate the clinical results of postureless (no intraoperative or postoperative posturing) Descemet’s membrane endothelial keratoplasty (DMEK) with the first postoperative review conducted at one week.

Design Retrospective, noncomparative, interventional case series.

Participants 17 consecutive eyes of 17 patients requiring DMEK with PI for any cause of endothelial failure.

Intervention DMEK was performed with an intraoperative inferior PI and a near total fill of SF6 (20% concentration). After filling the anterior chamber with gas there was no intraoperative tamponade time; at the conclusion of surgery the patient was sat up in theatre and an external eye examination was performed to confirm the gas meniscus was above the PI. The patient was allowed home immediately with no instructions to posture at home and the next scheduled review occurred at day 7.

Main Outcome Measures Rate of any postoperative complications, including any unplanned visits or intervention between day 0–7, graft detachment, rebubbling and primary failure rates.

Results There were zero additional or unplanned visits or interventions. No pupil block or Urrets-Zavalia syndrome occurred. No complications occurred other than partial (<1/3 DMEK surface area) detachment in the first month in 3/17 (17.6%) of which a rebubbling was performed in 2 (11.8%). Each of those required one rebubbling, after which total graft attachment was achieved. There were no cases of primary graft failure.

Conclusions This small series highlights that DMEK surgery can be safely performed with less demands of patients in the postoperative period for hospital reviews or of posturing.