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Different techniques for unfolding the Descemet graft in Descemet"s membrane endothelial keratoplasty (DMEK)

Session Details

Session Title: Cornea surgical I

Session Date/Time: Tuesday 08/10/2013 | 08:00-10:30

Paper Time: 09:12

Venue: Forum (Ground Floor)

First Author: : V.Liarakos GREECE

Co Author(s): :    I. Dapena   L. Ham   G. Melles         Dickman

Abstract Details

Purpose:

To define various Descemet-graft unfolding techniques in Descemet membrane endothelial keratoplasty (DMEK).

Setting:

Netherlands Institute for Innovative Ocular Surgery

Methods:

In a retrospective analysis, the surgical videos of 100 consecutive DMEK cases with at least six months of follow-up were evaluated and categorized. The Descemet-graft unfolding methods were categorized into four basic techniques and three auxiliary techniques.

Results:

All DMEK surgeries could be completed using (a combination of) four Descemet-graft unfolding techniques: Technique I: standardized ‘no-touch’ graft unfolding using a ‘double-roll’, Technique II: carpet-unrolling while fixating one graft-edge, Technique III: small air-bubble assisted unrolling and Technique IV: the ‘single sliding cannula maneuver’. Additional maneuvers included: turning-over the graft when oriented upside-down (‘flushing’); manual graft centration with a cannula; and ‘bubble-bumping’ to unfold peripheral ‘inward folds’. In 73% of surgeries Technique I was used, in 44% a combination of techniques, and auxiliary techniques in 62%. None of the techniques showed a correlation with the BCVA, endothelial cell density or postoperative complication rate (P>0.1).

Conclusions:

DMEK may be further facilitated by using controlled techniques for unfolding the Descemet-graft inside the recipient anterior chamber, either as stand-alone techniques or used in various combinations.

Financial Interest:

NONE