Combined Yamane Secondary IOL and DMEK in Aphakic Eyes after Vitrectomy

The conventional endothelium-out, chamber-shallowing, Descemet membrane endothelial keratoplasty (DMEK) tap technique is not well-suited for eyes after vitrectomy because the absence of a vitreous body renders the eye unicameral. The relative absence of posterior pressure and the posterior-to-anterior pressure gradient that results from releasing fluid from the anterior chamber dramatically limit the surgeon's ability to decrease the anterior chamber depth, which in turn makes the prospect of using a conventional DMEK tap technique foreboding. In this video, Drs. Christopher Sales and Yong Kam demonstrate an endothelium-in DMEK pull-through technique in which an anterior chamber (AC) maintainer is placed directly across from the main incision. The AC maintainer not only maintains AC depth, but it also directs the infusion current down the long axis "tube" of the tri-folded DMEK tissue, encouraging it to uncoil into an open configuration.

Financial Disclosures: Dr. Christopher Sales discloses a financial relationship with Network Medical Review (Patents/Royalty). Dr. Yong Kam discloses no financial relationships.