Posterior stromal ripples increase risk of Descemet's membrane endothelial keratoplasty graft detachment worsening over time.

Posterior stromal ripples and detachment axial extension >1/3 of graft surface area were the main risk factors for detachment worsening over time, and patients showing these features should be monitored closely to identify the need for re-bubbling at an early stage, thus improving surgical outcomes.