DMEK outcomes not affected by graft unfolding technique

The authors viewed videos of 100 Descemet membrane endothelial keratoplasty (DMEK) procedures in order to define Descemet graft unfolding techniques. They divided the techniques they observed into four basic techniques and three auxiliary techniques. All of the DMEK procedures were completed with these techniques, and none showed any correlation with visual acuity or endothelial cell density six months after the procedure or with the incidence of postoperative complications.

They examined videos of consecutive DMEK cases with at least six months of follow-up. All of the procedures were completed using a combination of the following four graft unfolding techniques:

• standardized no-touch graft unfolding using a double roll
• carpet unrolling while fixating one graft edge (Dirisamer technique)
• small air bubble-assisted unrolling (Dapena maneuver)
• single sliding cannula maneuver.

Additional maneuvers used included:

• turning over the graft when oriented upside down (flushing)
• manual graft centration with a cannula
• bubble bumping to unfold peripheral inward folds.

In 73 percent of the procedures, the standardized no-touch graft unfolding technique was used, while a combination of techniques was used in 44 percent, and auxiliary techniques in 62 percent.

The authors conclude that DMEK may be facilitated by using controlled techniques - either stand-alone or in various combinations - for unfolding the graft inside the recipient anterior chamber.