Posters

The 'ghost DMEK' technique: peripheral staining of Descemet's membrane endothelial keratoplasty (DMEK) grafts without using Trypan blue

Poster Details

First Author: E.Livny ISRAEL

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

Abstract Details

Purpose:

To describe a novel graft staining technique for DMEK surgery in which Trypan blue is not used to stain the graft prior to surgery, and only circular peripheral staining of the graft's borders is used. This technique allows for easy recognition of the graft orientation in the anterior chamber by simple observation, which obviates more complicated or expensive methods used to determine the graft orientation such as: The "blue cannula tip sign" (Moutsouris sign), use of oblique slit beam by hand-held slit lamp, use of intra-operative AS-OCT or marking an "F" or "S" on the grafts.

Setting:

Ophthalmology department of a tertiary hospital in Israel

Methods:

Partially pre-stripped grafts were put endothelium-side up. The inner part of the punch knife was marked by gentian violet marker. During trephination, the graft's borders were stained by gentian violet, keeping the rest of the graft un-stained. Then, DMEK surgery was performed without staining the grafts with Trypan blue. Graft unfolding and centration was possible due to its marked borders, and its orientation was determined by simple observation - due to the contrast between the stained graft borders to the rest of the unstained graft. Ten DMEK cases were operated by this novel technique.

Results:

In all cases, graft unfolding and centration in the anterior chamber was feasible without the use of Trypan blue. In all cases, the proper orientation of the graft was apparent by simple observation of the graft's borders without the necessity of using any of the aforementioned techniques. All cases were successfully concluded with clearing of the corneas operated and vision improvement.

Conclusions:

This novel technique enables quick and simple recognition of the graft orientation inside the anterior chamber - simply by observing it at the operating microscope, which obviates the need for more complicated or expensive techniques.

Financial Disclosure:

None