Descemet's stripping under automated continuous air flow in Descemet's membrane endothelial keratoplasty (DMEK): a technique

Session Details

Session Title: Cornea Surgical I

Session Date/Time: Monday 12/09/2016 | 08:00-10:30

Paper Time: 08:46

Venue: Hall C1

First Author: : E.Livny ISRAEL

Co Author(s): :    Y. Nahum   I. Gabay   I. Bahar              

Abstract Details

Purpose:

Host's Descemet's membrane (DM) stripping prior to DMEK graft transplantation should be performed meticulously in order to avoid any host's DM remnants in the graft-stroma interface, which may lead to graft detachment and sub-optimal visual results. To this end, we are describing a technique for automated continuous air flow into the anterior chamber (AC) which allows for an excellent visualization during Descemet's membrane stripping in DMEK surgeries, without the necessity of repeated filling of the AC with air which often occurs when continuous air injection is not used.

Setting:

Ophthalmology department, Rabin Medical Center, Petach-Tikva, Israel

Methods:

A 20-gauge AC maintainer is inserted into the AC through a stab incision. The AC maintainer is connected to a 3-way tap - one connection to an elevated BSS bottle and the other to the fluid-air exchange port of the vitrectomy device (Stellaris Vitreoretinal System, Bausch & Lomb, Rochester, New York). The air pressure upper limit should be set to 25mmHg throughout the procedure. Then, reverse Price-Sinskey hook is used to score the circumferential margins of the host's Descemet. Descemet stripping is then performed under continuous air flow with excellent visualization in a perfectly stable AC filled with air.

Results:

Twenty five cases of Descemet's stripping under continuous automated air infusion during DMEK surgery were performed. There were no complications regarding this step in all surgeries.

Conclusions:

Thorough Descemet's stripping during DMEK surgery is imperative for favorable post-operative results and avoidance of complications. In our experience, performing this step under air in the AC contributes to the best visualization possible - thus the best possible results. We present our experience with automated continuous air infusion to the AC via an AC maintainer connected to a vitrectomy device fluid-air pump, which provides a stable AC under air during this step.

Financial Disclosure:

NONE