Comparison of Descemet stripping under continuous air flow, manual air injection and balanced salt solution for DMEK: a pilot study

Graefes Arch Clin Exp Ophthalmol. 2017 Aug;255(8):1605-1611. doi: 10.1007/s00417-017-3675-0. Epub 2017 Apr 29.

Abstract

Background: Descemet's membrane endothelial keratoplasty (DMEK) involves removal of the recipient's Descemet membrane (DM) prior to transplanting the donor's DM. When using balanced salt solution (BSS) or ophthalmic viscosurgical devices (OVDs), visualization of the host's DM during its stripping may be inadequate and may result in Descemet remnants and could lead to sub-optimal surgical results. Previous articles described excellent visualization when utilizing air injection but this requires repeated air injection into the anterior chamber (AC). We present a pilot study that compares different techniques under which DM stripping can be performed: with continuous automated air infusion, with manual air infusion, and with BSS.

Methods: We retrospectively compared video footage of DM stripping with BSS, with continuous air and with manual injection of air into the AC to determine DM stripping duration and the number of times the surgeon had to insert and retrieve a surgical instrument from the AC.

Results: Thirty videos of 10 consecutive cases of the three DM stripping techniques were evaluated. DM stripping duration was 3.26 (±1.32), 3.92 (±1.2) and 12.9 (±3.98) minutes for BSS, continuous air flow, and manual air injection, respectively. Frequency of instrument retrieval (FIR) was 3.6 (±1.71), 1.5 (±0.71) and 15.1 (±3.28) for BSS, continuous air flow, and manual air injection, respectively. Continuous air flow and BSS were both statistically different than manual air injection into the AC (p < 0.05), but did not differ from one another statistically.

Conclusion: DM stripping during posterior lamellar surgery is imperative for favorable post-operative results and prevention of complications. Performing this step under air in the AC contributes to better visualization and an efficient surgery.

Keywords: Corneal transplantation; DMEK; Descemetorhexis; Endothelium.

Publication types

  • Comparative Study
  • Video-Audio Media

MeSH terms

  • Aged
  • Aged, 80 and over
  • Air
  • Anterior Chamber
  • Descemet Stripping Endothelial Keratoplasty / methods*
  • Female
  • Follow-Up Studies
  • Fuchs' Endothelial Dystrophy / diagnosis
  • Fuchs' Endothelial Dystrophy / surgery*
  • Humans
  • Injections
  • Male
  • Middle Aged
  • Pilot Projects
  • Retrospective Studies
  • Sodium Chloride / administration & dosage*
  • Visual Acuity

Substances

  • Sodium Chloride