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Choosing the appropriate technique makes DMEK graft unfolding easier, safer
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MILAN — Choosing the most suitable approach from a variety of controlled techniques for unfolding the graft can make Descemet’s membrane endothelial keratoplasty safer and easier to perform, according to one surgeon here.
Descemet’s unfolding methods were categorized into four basic techniques after a retrospective video analysis of 100 DMEK cases.
Miguel Naveiras
“First is the standardized no-touch technique, suitable in most cases for standard-thickness double-roll grafts. A bubble is placed in the middle of the two curls. As it enlarges, it spreads the roll onto the iris,” Miguel Naveiras, MD, said at the European Society of Cataract and Refractive Surgeons meeting.
Naveiras described the second technique as “carpet unrolling.” While fixating one edge of the graft with a cannula, another cannula is used from the outside to unroll the graft like a carpet. This technique is suitable for very tight single or double rolls, he said.
The third technique, suitable for average rolls, whether single or double, is the small air bubble maneuver. A small air bubble is injected and then enlarged by gentle pressure and friction of the cannula, opening up the roll.
The fourth technique is a single sliding cannula maneuver in which no air is used within the anterior chamber. It is suitable for loose rolls that become unfolded by pressing on top of them with the cannula, Naveiras said.
“We use the standard technique in 73% of the cases and a combination of techniques in 44% of the cases,” he said.
Disclosure: Naveiras has no relevant financial disclosures.