COPENHAGEN — A new technique allows for faster and safer Descemet’s separation in Descemet’s membrane endothelial keratoplasty, with less risk of endothelial damage, according to one surgeon speaking at the EuCornea meeting.
The technique, named hydroseparation, uses balanced salt solution or Ringer’s solution to separate the membrane without touching the endothelial surface and can be performed on both the donor and recipient cornea, Pavel Stodulka, MD, PhD, said.
A small tear is made at the periphery of the Descemet’s membrane, and a tunnel is created with a spatula. Then, the liquid is injected, using trypan blue, if desired, to stain the membrane and make the graft easier to visualize and handle.
“The membrane usually separates easily all the way through its periphery,” Stodulka said. “The fluid is then aspirated, the cornea is trephined, and the membrane is gently peeled off with tiny forceps. It folds into a roll or double roll and is stained again by trypan blue.”
The same hydroseparation procedure can be performed in the recipient cornea.
“The tricky part is to find the access between Descemet and corneal stroma — the rest is easy and quick,” Stodulka said. “As soon as the access is found, you put your cannula there, hydroseparate the membrane from the stroma, lift it with tiny forceps at the periphery, peel it off in one piece and finally inject the membrane of the donor.”
Hydroseparation was successfully used in 16 consecutive eyes treated with DMEK alone or DMEK and cataract surgery. Minimal loss of endothelial cell density was observed, visual acuity improved significantly, and refraction was close to zero with no induced astigmatism. – by Michela Cimberle
Stodulka P. Hydroseparation of Descemet membrane endothelial graft for DMEK. Presented at EuCornea; Sept 9-10, 2016; Copenhagen, Denmark.
Disclosure: Stodulka reports no relevant financial disclosures.