VIDEO: Small relaxing incisions may allow easier DMEK surgery

Mark S. Hansen, MD, and David R. Hardten, MD, demonstrate a novel technique that facilitates performance of Descemet’s membrane endothelial keratoplasty.

The technique incorporates two small relaxing incisions placed approximately 4 clock hours apart at the peripheral edge of the graft tissue, forming an area where the graft can kink, thus aiding the creation of a triangular configuration of the graft. Air can then be easily placed under the graft to bring it up onto the posterior stroma.

In this video, after the paracentesis and main incisions are made, the Descemet’s membrane is scored using a reverse Sinskey hook and stripped with a 90° scraper. Trypan blue is used to stain the edge of Descemet’s membrane on the donor graft. Excess trypan is removed with a sponge, and the graft is then punched with a trephine of the desired size. The rim of cut Descemet’s membrane is removed. The relaxing incisions are then made with a 75-blade on either side of the hinge, located by the notch made on the sclera. The graft is then grasped with non-toothed forceps and removed from the stroma. The graft is stained in trypan and placed in an injection cartridge. It is then injected into the anterior chamber, and the main incision is sutured. Gentle strokes on the cornea with a cannula are used to easily achieve the trifold configuration of the graft, and air is placed posterior to the graft. The graft edges are unfolded utilizing the posterior support of the air bubble. The anterior chamber is then filled with gas or air.

Read more about this technique in the May 10, 2019, issue of Ocular Surgery News.