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    DMEK in a Pseudophakic Eye

    By Francis W. Price Jr., MD
    Cornea/External Disease

    In this case of a pseudophakic eye, Dr. Francis Price demonstrates how to perform Descemet's membrane endothelial keratoplasty (DMEK). Following the creation of two stab incisions, a trephine is used to lightly mark the epithelium and demaracate where Descemet's membrane will be stripped. Dr. Price places air in the anterior chamber to provide optimal contrast when scoring the membrane. Trypan blue is used in the host cornea to identify any membrane remnants. A 2.8-mm temporal incision is made in the clear cornea, and any remnants are removed using bimanual irrigation/aspiration through the two stab incisions.

    Attention turns to the donor tissue. Trypan blue is used once more to visualize the donor membrane and assist in distinguishing the curled edges when placed in the host. Dr. Price uses a closed IOL cartridge system to inject the donor graft through the main temporal incision. The incision is then sutured to avoid risk of expulsion of the donor membrane. Short bursts of balance salt solution (BSS) are used to unfold the donor tissue, and a small air bubble is placed under the graft which is positioned further with a bent needle. Finally, the anterior chamber is filled completely with air to press the donor against the host stroma.