Posters

The "Joghurt Technique" in DMEK graft harvesting: a quick and safe method for both inexperienced and senior surgeons

Poster Details

First Author: A.Tzamalis UK

Co Author(s): R. Vinciguerra   V. Romano   E. Arbabi   D. Borroni   N. Ziakas   S. Kaye     

Abstract Details

Purpose:

DMEK graft dissection techniques are diverse and feature different strengths and weaknesses. The aim of this study was to describe and evaluate the efficacy and safety of a novel technique to harvest DMEK donor grafts utilizing a newly designed partial thickness hinge trephine.

Setting:

1. St. Paul's Eye Unit Royal Liverpool University Hospital Liverpool, UK 2. Department of Ophthalmology Aristotle Univeristy of Thessaloniki Papageorgiou General Hospital Thessaloniki, Greece

Methods:

After the donor corneoscleral disc is secured with vacuum on the cutting block and stained with trypan blue, a partial thickness trephination with a 200μm-guarded trephine is performed avoiding rotational movements. The novel trephine has a circular guarded blade missing one clock-hour, creating an uncut hinge on the donor cornea. Additionally, two straight cuts are made by the trephine perpendicular to the edge of trephination towards the trabecular meshwork in the hinge area. Descemet’s membrane is lifted from the Schwalbe’s line of the hinge area and DMEK graft is unpeeled after desired marking without further preparation.

Results:

3 surgeons of different experience level on endothelial keratoplasty (senior surgeon, independent surgeon, fellow) have applied the new technique in 24 donor corneas, divided in equal groups and all the graft preparations were recorded and further analyzed. 1 failure in graft preparation was noted defined as radial tears extending more than one quarter of the graft diameter. The mean preparation time was 6.21 ± 2.17 minutes, varying between 5.78 ± 1.93 minutes (senior surgeon) and 7.23 ± 2.32 minutes (fellow). No statistical significant differences were noted in preparation success rate, duration and endothelial cell loss between surgeons (p>0.05).

Conclusions:

This new graft preparation technique, by means of a guarded hinge trephine simulating opening a cup of joghurt seems to be a safe and efficient way of harvesting donor corneas for Descemet membrane endothelial keratoplasty providing a shorter preparation time and low rate of preparation failure independently of the surgeon’s experience level.

Financial Disclosure:

None