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VIDEO: Hydroseparation provides faster, easier way to deal with DMEK graft
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This video shows a technique that, according to Pavel Stodulka, MD, PhD, allows for faster and safer Descemet’s separation in Descemet’s membrane endothelial keratoplasty, with less risk of endothelial damage.
The technique, named hydroseparation, uses balanced salt solution or Ringer’s solution to separate the membrane without touching the endothelial surface and can be performed on both the donor and recipient corneas.
- A small tunnel under Descemet’s membrane is made at the periphery outside of a pigmented ring.
- A tunnel is created with a spatula.
- The liquid is injected, using diluted trypan blue, if desired, to stain the membrane and make the graft easier to visualize and handle.
“The membrane usually separates easily all the way through its periphery,” Stodulka said.
The fluid is then aspirated, the cornea is trephined, and the already hydroseparated membrane is gently peeled off with tiny forceps.
“It folds into a roll or double roll and is stained again by trypan blue,” Stodulka said.
A similar hydroseparation procedure can be performed in the recipient cornea.
- A spatula is introduced through a side-port incision between the Descemet’s membrane and stroma to create a short tunnel.
- The flat end cannula connected to a syringe with Ringer’s solution is introduced in this tunnel, and the recipient Descemet’s membrane is hydroseparated by injecting Ringer’s solution.
- The Descemet’s membrane is then peeled off by endo forceps.
“The tricky part is to find the access between Descemet and corneal stroma — the rest is easy and quick,” Stodulka said. “As soon as the access is found, you put your cannula there, hydroseparate the membrane from the stroma, lift it with tiny forceps at the periphery, peel it off in one or several pieces, and finally inject the membrane of the donor.”
Hydroseparation was successfully used in 16 consecutive eyes treated with DMEK alone or DMEK and cataract surgery. Minimal loss of endothelial cell density was observed, visual acuity improved significantly, and refraction change was close to zero with .075 D cylinder of subjective astigmatism. – by Michela Cimberle
Disclosure: Stodulka reports no relevant financial disclosures.