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The DMEK “Wave” maneuver

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First Author: I.Lavy ISRAEL

Co Author(s):    E. Nche   A. Katzir   K. Safadi   A. Solomon           

Abstract Details

Purpose:

To describe a novel technique for Descemet Membrane Endothelial Keratoplasty (DMEK) graft handling and centration without endothelium touching the inferior part of the anterior chamber, thus, suitable for vitrectomized eyes, deep anterior chamber (AC), AC IOL’s and potentially reducing surgery time and endothelial cells loss during DMEK surgery.

Setting:

Ophthalmology department, Hadassah University Medical Center, Jerusalem, Israel

Methods:

A retrospective interventional case series of 18 challenging DMEK cases, 6 AC IOL’s, 14 vitrectomized eyes, 11 of them fully vitrectomized, 4 post-glaucoma surgery, 3 IOL suturing during surgery and 4 with large iris defect eyes. In all cases the DMEK “Wave” maneuver was utilized to attach and center the DMEK graft to the posterior cornea without assisting the bottom of the anterior chamber (AC). Then, eyes were evaluated intra and post operatively for successful graft attachment and centration.

Results:

In all the cases where the “Wave maneuver” was performed, DMEK grafts were successfully attached and centered at the end of the surgery. Intraoperatively, no maneuver related complications were observed. Post operatively, 15 corneas cleared (mean follow up time 6 months), 2 primary graft failures, 6 eyes needed re-bubble procedure, one month post operatively, one eye had herpetic keratitis, that eventually ended in graft failure. The maneuver was performed by two surgeons with equal success rate.

Conclusions:

The DMEK “Wave maneuver” can be very helpful in advanced DMEK cases where the anterior chamber is either very deep, the eye is vitrectomized or the bottom of the anterior chamber is compromised like in the case of AC IOL. The “Wave maneuver” was easily learned by another surgeon.

Financial Disclosure:

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