Novel technique, surgical device facilitate Descemet graft dissection
AMSTERDAM — A novel technique and a simple surgical device may facilitate the preparation of the Descemet graft for Descemet’s membrane endothelial keratoplasty, according to one speaker.
The technique entails preparation of the endothelial graft by incomplete circular trephination and was successfully used in 50 patients with Fuchs' dystrophy. A trephine was then specifically designed, with an interruption of the blade and the two extremities curved to the outside to avoid tearing of the Descemet.
“The aim is to isolate a small flap in front of the area where there is no trephination. There, it is easy to find the plane of dissection with forceps. You slide a 27 gauge needle mounted on a syringe filled with BSS and then use hydrodissection to go straight to the center. You’ll see the Descemet rising, and then you can slide on the right and left towards the periphery,” Marc Murain, MD, explained at the Eucornea meeting.
The graft is detached in 4-5 minutes. The Descemet’s membrane side is then stained, protected with viscoelastic and rolled up with the endothelium inside.
Sixteen grafts were prepared using this technique by a corneal bank technician, a resident and a cataract surgeon. The three operators had never tried to dissect a DMEK graft before.
“The Descemet graft could be easily dissected in 14 cases. In 2 cases, the resident was able to isolate the graft but perforated it. Endothelial cell count showed minimal loss of cells and histological sections confirm that the cleavage was between Descemet and posterior stroma,” Muraine said.