Advanced Descemet's membrane endothelial keratoplasty (DMEK) for complex endothelial disorders

Session Details

Session Title: Cornea
Session Date/Time: Friday 10/02/2017 | 08:30-10:00
Paper Time: 09:36
Venue: Brussels Room 0.4

First Author: R.Quilendrino THE NETHERLANDS
Co Author(s): I. Dapena  L. Baydoun  G. Melles           

Abstract Details

Purpose:

To describe advanced Descemet membrane endothelial keratoplasty (DMEK) and its technical modifications to standardized ﾓno ﾭtouchﾔ DMEK for handling complex, endothelial disorders.

Setting:

Netherlands Institute for Innovative Ocular Surgery / Tertiary referral center

Methods:

Complex DMEK cases (severe, long standing corneal edema; previously failed penetrating keratoplasty (PK) or endothelial keratoplasty (EK) grafts; eyes at risk for hypotony; eyes with large iris defects, after vitrectomy; eyes with a glaucoma drainage device (GDD) tube and/or anterior chamber intraocular lens (ACﾭIOL); phakic eyes; and/or eyes with a shallow AC), were included in this study. Modifications of the DMEK-technique were evaluated by intraoperative video recordings and anterior segment optical coherence tomography images.

Results:

Failed PK grafts required a modified descemetorhexis, sizing and positioning of the DMEK-graft. Removal of a failed EK graft was more difficult than a descemetorhexis in primary DMEK. Pressurization and air-fluid exchange was modified in case of excessive corneal edema and/or hypotony. A specific air bubble maneuver was utilized to lift a DMEK-graft in the presence of a GDD tube. An angle-supported AC-IOL should be removed, whereas stable iris-fixated AC-IOLs may be left in-situ.

Conclusions:

Advanced DMEK may include technical adjustments to facilitate managing complex endothelial disorders.

Financial Disclosure:

receives consulting fees, retainer, or contract payments from a company producing, developing or supplying the product or procedure presented