Flipping a DMEK Graft

Dr. Christopher Sales illustrates the Dos and Don'ts of flipping a DMEK graft, using a case from former fellow Dr. Andrea Blitzer.

Do: Deepen the chamber to provide sufficient space for the tissue to reform a scroll; orient the scroll perpendicular to the direction of balanced-saline-solution (BSS) injection; direct a jet of BSS along the iris plane toward the scrolled-up side of the tissue to make the tissue roll over; minimize burping fluid from the paracentesis during BSS injection.

Don't: Try to flip an unfurled DMEK scroll in a shallow chamber—there won't be enough space for it to roll over; inadvertently burp fluid from the paracentesis while injecting BSS—it will create a fluid current that will cause the tissue to rush toward the cannula.

Financial Disclosures: Dr. Christopher Sales discloses a financial relationship with Network Medical Review (Patents/Royalty).