NOV 02, 2012
DMEK in a Phakic Eye
DSEK Push-In Technique
DMEK Triple Procedure
Dr. Francis Price demonstrates cataract surgery, IOL implantation, and Descemet's membrane endothelial keratoplasty (DMEK). Following the creation of two stab incisions, a 2.8-mm temporal incision is made. A capsulorhexis is completed, and typical phacoemulsification and IOL implantation are performed through the primary incision. A trephine is used to lightly mark the corneal epithelium and demarcate where Descemet's membrane will be stripped. Descemet’s membrane is stripped under cohesive viscoelastic. After removal of viscoelastic, Miochol-E is used to constrict the pupil. An inferior peripheral iridotomy is made with intraocular scissors. Bimanual irrigation/aspiration is used to completely remove any membrane remnants before injecting the donor tissue, because remaining remnants or loose edges can impair graft adherence.
Attention turns to the donor tissue. Trypan blue is used to visualize the donor membrane and assist in distinguishing the curled edges when placed in the host eye. 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. The donor is inspected with a handheld slit beam to ensure the endothelium is facing the iris. A small air bubble is placed under the graft, and an irrigation cannula is gently swept across the surface of the host cornea to center the graft. Finally, the anterior chamber is filled completely with air to press the donor against the host stroma.