Posters

Transition to Descemet's membrane endothelial keratoplasty (DMEK): conquering the learning curve

Poster Details

First Author: M.Mathew UK

Co Author(s):    S. Ghosh   R. Hussain   A. Pradeep   V. Savant     

Abstract Details

Purpose:

To describe our initial experience towards starting DMEK in a tertiary centre Cornea unit with video clips demonstrating the technique

Setting:

Leicester Royal Infirmary, University Hospitals Leicester

Methods:

Preliminary preparation: - Training courses, observing contemporaries and surgical videos - Wet lab practice on human corneas The following technique was performed on patients. Donor preparation: Superficial trephination within trabecular meshwork Highlight DM edges with trypan blue Circumferential stripping of DM Peripheral rips removed by performing circular rhexis directed outwards Donor insertion: DORC DMEK kit used 2 techniques for Unfolding of DM - with / without air 1. DM unscrolled with small air bubble between folds 2.Tapping on central cornea with modulation of AC depth without using air. Controlled Air injection with 30g needle through separate entry site at limbus.

Results:

The primary challenge noted, was in identification of the trephined edge of the DM and finding the right cleavage plane between the DM and the underlying stroma. This improved on repeating the procedure on subsequent donor tissues. Dealing with peripheral rips early, prevented central extensions and loss of donor tissue. Both techniques of unscrolling DM in anterior chamber worked well with the air bubble technique being better in tighter scrolls. Despite being novices in DMEK our success rate in donor preparation was 85%.

Conclusions:

DMEK is considered a technically challenging procedure. Difficult donor preparation and insertion are limiting factors for DSAEK surgeons learning this new technique. Improved understanding of endothelial tissue behaviour and instrumentation help overcome these factors. Background literature, wet lab experience and careful attention to detail made our transition to DMEK easier. FINANCIAL INTEREST: NONE