This video shows a case in our series of Descemet’s membrane endothelial keratoplasty in challenging cases, soon due for publication.
The patient was referred to our clinic because of extensive corneal edema, due to multiple surgeries, following complicated cataract surgery. In addition to large peripheral anterior synechia (PAS) and aphakia, multiple vitrectomies were performed due to retinal detachments.
A crucial step before DMEK surgery is to rebuild a “lens plane,” ie, build a barrier to the vitreous cavity for proper air bubble support at the end of surgery. Further anterior chamber reconstruction in terms of loosening PAS is mandatory, which was challenging in this particular case and not possible without creating minor damage to the iris.
Descemetorhexis was easily performed under air, and following the evaluation of sufficient capsule support for IOL fixation in the ciliary sulcus, a clear corneal incision was made and a three-piece IOL was implanted.
Injecting the DMEK graft was easy, but due to the very deep anterior chamber and the elastic properties of the graft, unfolding and centering of the DMEK roll was quite challenging. At the end of surgery, a slight decentration of the graft was accepted in order to avoid further tissue manipulation. Three months postoperatively, the patient achieved a best corrected visual acuity of 20/40 and a clear cornea with pachymetry levels down to normal.
- For more information:
- Martin Dirisamer, MD, a YO member of the OSN Europe Edition Board, can be reached at Department of Ophthalmology, General Hospital Linz, Austria; email: email@example.com.