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A simple rescue maneuver for unfolding and centering a tightly rolled graft in Descemet membrane endothelial keratoplasty

Authors Droutsas K, Bertelmann T, Schroeder FM, Papaconstantinou D, Sekundo W

Received 4 October 2013

Accepted for publication 29 November 2013

Published 24 October 2014 Volume 2014:8 Pages 2161—2163


Checked for plagiarism Yes

Review by Single anonymous peer review

Peer reviewer comments 4

Konstantinos Droutsas,1,2 Thomas Bertelmann,1 Frank M Schroeder,1 Dimitrios Papaconstantinou,2 Walter Sekundo1

1Department of Ophthalmology, Philipps University, Marburg, Germany; 2First Department of Ophthalmology, University of Athens, Medical School of Athens, Athens, Greece

Abstract: A 74-year-old man underwent Descemet membrane endothelial keratoplasty (DMEK) for endothelial decompensation due to Fuchs endothelial dystrophy. After descemetorhexis, the DMEK graft was inserted into the anterior chamber. However, unfolding of the graft was not possible as the graft was very tightly rolled together and the anterior chamber deep. After placing a 30G-cannula connected to an air-filled syringe inside the roll's lumen, a small air bubble was injected, which allowed the roll to open up, until it assumed a “taco” configuration around the bubble. Then, the graft was centered by pressing the posterior part of the roll against, and sweeping it over the iris. In the present case a “tight” DMEK roll was successfully unfolded by injection of a single air bubble into the roll’s lumen and centered by a “sweeping” the partialy unfolded graft over the iris. This technique allowed a controlled unfolding and centering of the DMEK graft with limited trauma to the donor endothelium and may be applied in cases where other less traumatic maneuvers are not successful.

Keywords: Fuchs endothelial dystrophy, surgical technique, endothelial keratoplasty

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