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New technique facilitates DMEK graft preparation, insertion
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BARCELONA — A novel technique for safe donor preparation and endothelium-inward injection of the graft roll makes Descemet’s membrane endothelial keratoplasty easier and more reproducible, according to one surgeon.
“Descemet’s graft preparation is not always easy due to the risk of tears starting from the extreme periphery. Unfolding is often challenging and it is difficult to be sure that the graft is not upside down, especially when the cornea is cloudy,” Marc Muraine, MD, said at the EuCornea meeting.
Marc Muraine
His “inverted DMEK” technique entails placing the corneal button endothelium-up on an artificial chamber, staining it with trypan blue to mark the periphery and then removing the peripheral ring, leaving two triangular hinges at either side.
“Delamination and hydrodissection of the Descemet membrane is then performed, starting from under the two hinges. Once the Descemet graft is obtained, the two hinges are cut, the graft is folded in a ‘burrito’ shape, endothelium inside, marked on the external side and inserted in an IOL cartridge. [Balanced salt solution] is injected to facilitate unfolding and once the graft is centered, the air bubble is insufflated,” Muraine said.
Muraine successfully used the inverted DMEK technique in a study including 50 eyes.
“This technique is making a challenging procedure easier and safer,” he said. — by Michela Cimberle
Disclosure: Muraine reports no relevant financial disclosures.