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

Droutsas K, Bertelmann T, Schroeder FM, Papaconstantinou D, Sekundo W - Clin Ophthalmol (2014)

Bottom Line: 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.

View Article: PubMed Central - PubMed

Affiliation: Department of Ophthalmology, Philipps University, Marburg, Germany ; First 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.

No MeSH data available.


Related in: MedlinePlus

Stages of the “rescue” maneuver.Notes: (A) The cannula tip is positioned halfway into the lumen of the tightly rolled Descemet membrane endothelial keratoplasty graft. (B) A small air bubble is injected in a slow and controlled fashion. Note that the bubble is not round, but is nearly cylindrical, conforming to the roll’s lumen, due to the high resistance of the graft to being unfolded. (C) The expanding air bubble unfolds the roll. (D) The graft forms a “taco” around the air bubble, with its opening facing the anterior chamber angle. (E) The graft is centered by gently sweeping it with the cannula under the bubble. (F) After removing the air bubble anterior to the graft, another air bubble is injected under the graft in order to lift it against the recipient’s cornea.
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f1-opth-8-2161: Stages of the “rescue” maneuver.Notes: (A) The cannula tip is positioned halfway into the lumen of the tightly rolled Descemet membrane endothelial keratoplasty graft. (B) A small air bubble is injected in a slow and controlled fashion. Note that the bubble is not round, but is nearly cylindrical, conforming to the roll’s lumen, due to the high resistance of the graft to being unfolded. (C) The expanding air bubble unfolds the roll. (D) The graft forms a “taco” around the air bubble, with its opening facing the anterior chamber angle. (E) The graft is centered by gently sweeping it with the cannula under the bubble. (F) After removing the air bubble anterior to the graft, another air bubble is injected under the graft in order to lift it against the recipient’s cornea.

Mentions: In a further attempt, a 30 gauge cannula connected to an air-filled tuberculin syringe was positioned inside the roll’s lumen (Figure 1A), and air was slowly injected in order to achieve a controlled opening up of the roll (Figure 1B and C), until it assumed a “taco” configuration around the bubble, with its opening facing the anterior chamber angle (Figure 1D). Then, using a 30 gauge cannula (DMEK surgical disposable set; D.O.R.C.), the graft’s periphery was pressed against the iris and centered by sweeping the graft over the iris (Figure 1E). The air bubble was enlarged until the graft was completely unfolded. Finally, the air between the graft and the host cornea was removed and the graft was appositioned against the cornea by injection of another air bubble posterior to the graft (Figure 1F). The eye was left with a maximal air fill at the end of surgery in order to allow adherence of the donor to the host cornea; after 2 hours, a small amount of air was released at the slit lamp by pressing on a side port, in order to avoid an increase of intraocular pressure.


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

Droutsas K, Bertelmann T, Schroeder FM, Papaconstantinou D, Sekundo W - Clin Ophthalmol (2014)

Stages of the “rescue” maneuver.Notes: (A) The cannula tip is positioned halfway into the lumen of the tightly rolled Descemet membrane endothelial keratoplasty graft. (B) A small air bubble is injected in a slow and controlled fashion. Note that the bubble is not round, but is nearly cylindrical, conforming to the roll’s lumen, due to the high resistance of the graft to being unfolded. (C) The expanding air bubble unfolds the roll. (D) The graft forms a “taco” around the air bubble, with its opening facing the anterior chamber angle. (E) The graft is centered by gently sweeping it with the cannula under the bubble. (F) After removing the air bubble anterior to the graft, another air bubble is injected under the graft in order to lift it against the recipient’s cornea.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4216047&req=5

f1-opth-8-2161: Stages of the “rescue” maneuver.Notes: (A) The cannula tip is positioned halfway into the lumen of the tightly rolled Descemet membrane endothelial keratoplasty graft. (B) A small air bubble is injected in a slow and controlled fashion. Note that the bubble is not round, but is nearly cylindrical, conforming to the roll’s lumen, due to the high resistance of the graft to being unfolded. (C) The expanding air bubble unfolds the roll. (D) The graft forms a “taco” around the air bubble, with its opening facing the anterior chamber angle. (E) The graft is centered by gently sweeping it with the cannula under the bubble. (F) After removing the air bubble anterior to the graft, another air bubble is injected under the graft in order to lift it against the recipient’s cornea.
Mentions: In a further attempt, a 30 gauge cannula connected to an air-filled tuberculin syringe was positioned inside the roll’s lumen (Figure 1A), and air was slowly injected in order to achieve a controlled opening up of the roll (Figure 1B and C), until it assumed a “taco” configuration around the bubble, with its opening facing the anterior chamber angle (Figure 1D). Then, using a 30 gauge cannula (DMEK surgical disposable set; D.O.R.C.), the graft’s periphery was pressed against the iris and centered by sweeping the graft over the iris (Figure 1E). The air bubble was enlarged until the graft was completely unfolded. Finally, the air between the graft and the host cornea was removed and the graft was appositioned against the cornea by injection of another air bubble posterior to the graft (Figure 1F). The eye was left with a maximal air fill at the end of surgery in order to allow adherence of the donor to the host cornea; after 2 hours, a small amount of air was released at the slit lamp by pressing on a side port, in order to avoid an increase of intraocular pressure.

Bottom Line: 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.

View Article: PubMed Central - PubMed

Affiliation: Department of Ophthalmology, Philipps University, Marburg, Germany ; First 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.

No MeSH data available.


Related in: MedlinePlus