Purchase this article with an account.
Romeo Altafini, Roberto Cian, Pietro Viola, Sandro Soldati; Technique to “F” mark DMEK Graft. Invest. Ophthalmol. Vis. Sci. 2015;56(7 ):1590.
Download citation file:
© ARVO (1962-2015); The Authors (2016-present)
Preparation, management and correct orientation of the donor graft are issues that have a part in preventing the wide spread of DMEK surgery. We describe a simple technique to draw an F on the donor graft during preparation on the artificial anterior chamber using a flat spatula painted in gentian violet.<br />
30 eyes of 30 patients with Fuchs’s dystrophy were underwent to DMEK surgery. 15 with Muraine’s technique (group A) and 15 with our marking addition technique (group B). We propose to slide a flat spatula, painted in gentian violet, on the stroma underlaying the folded graft which will generate a straight violet line printed on the stroma which will transfer by contact the color as the spatula is removed. Repeat three times this maneuver in order to have an inverted “F” letter painted on graft Descemetic side. Follow up examination were permormed at month 1,3 and 6. Early complication such as graft detachment or failure to restore clear cornea and endothelial cell count were performed at every visit. Non contact corneal specular microscopy (Tomey 3000 tm) was performed in all eyes 1st, 3rd , 6th months after surgery. Endothelial cell density (CCD), coefficient of variation in cell size (CV) and percentage of hexagram cells (HEX) between the two groups were considered after surgery. One-way analysis of variance (ANOVA) was used to analyze endothelial cell loss differences between two groups
The mean postoperatively endothelial cell loss was 8.8% at the 1st month, 10.5% at 3rd month and 12,6 % at 6th month in group 1 and 8% at 1st month, 10,2% at 3rd month and 12,3 % at 6th month in the group 2. There were no statistical differences in endothelial cell loss percentages between the two groups. We had 2 primary graft failure in group A (upside-down graft) and no graft failure in group B. No statistical differences in re-bubbling rate between the two groups.<br />
Many other technique have been used to visualize the proper orientation of the graft such as: shape-cutting the edge of the lamella, handhelded slit beam and E-DMEK. The one we’re proposing it’s a DSAEK style technique wich is diffusely used and therefore more familiar to the vast majority of corneal surgeon. According to these preliminary results this is an easy and safe technique to unequivocally judge the correct orientation of the graft. This marking technique will help in saving corneas even for a beginner DMEK surgeon.<br />
This PDF is available to Subscribers Only