Issue: May 10, 2021
Disclosures: Parker reports he is a consultant for DORC Ophthalmic, Glaukos and Ziemer.
February 12, 2021
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Terry squeegee can be used to remove host Descemet’s membrane remnants

Issue: May 10, 2021
Disclosures: Parker reports he is a consultant for DORC Ophthalmic, Glaukos and Ziemer.
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Following Descemet’s membrane endothelial keratoplasty, retained remnants of host Descemet’s membrane may interfere with graft attachment and compromise the optical quality of the transplanted cornea.

Commonly, these remnants may present as shreds of partially stripped Descemet’s membrane (ie, areas in which the posterior/non-banded layer of Descemet’s membrane has been peeled away, leaving the anterior/banded layer behind). Removal of these fragments may be challenging because they are often too insubstantial to engage with micro-grasping forceps and because scraping with metallic instruments risks damaging the cornea’s stromal fibers. Recently, however, we have discovered that an inexpensive, widely available instrument can be repurposed for the atraumatic elimination of these remnants — the Terry squeegee.

Source: Jack S. Parker, MD, PhD
Figure 1. A Descemet’s membrane remnant (a, white arrow) that has resisted removal by inverted Sinskey hook may be atraumatically polished from the posterior corneal surface via the Terry squeegee (b).
Source: Jack S. Parker, MD, PhD

The Terry squeegee (also known as the Terry capsule polisher) consists of a silicone tip fitted to the end of a 23-gauge or 27-gauge cannula, designed for polishing the posterior capsule after phacoemulsification. The device is sufficiently rigid to separate stuck-on cells, yet flexible enough to avoid inadvertent damage to surrounding structures.

Jack S. Parker

Interestingly, with the anterior chamber filled with air or viscoelastic, the Terry squeegee may be similarly employed to polish Descemet’s membrane remnants from the posterior cornea, akin to polishing lens epithelial cells from the posterior capsule. In our experience, the process is intuitive and highly effective, particularly for removing friable fragments that otherwise resist manipulation (Figure 1). Further, the instrument’s silicone tip poses a relative low risk of disrupting the cornea’s posterior stroma fibers compared with some metallic scrapers.

Therefore, the Terry squeegee may be considered as a safe and effective alternative to common metallic instruments for the removal of Descemet’s membrane remnants, theoretically reducing the risk of postoperative graft detachment and/or suboptimal visual results.

References:

Dirisamer M, et al. Acta Ophthalmol. 2013;doi:10.1111/j.1755-3768.2012.02504.x.

Müller TM, et al. Ophthalmology. 2016;doi:10.1016/j.ophtha.2016.08.014.

Satue M, et al. Cornea. 2016;doi:10.1097/ICO.0000000000000925.

Uchida H, et al. Nippon Ganka Gakkai Zasshi. 1991;95:1117-1123.

For more information:

Jack S. Parker, MD, PhD, can be reached at Parker Cornea, 700 18th St. South, Suite 503, Birmingham, AL 35233; email: jack.parker@gmail.com.