Intraocular graft unfolding techniques in descemet membrane endothelial keratoplasty

JAMA Ophthalmol. 2013 Jan;131(1):29-35. doi: 10.1001/2013.jamaophthalmol.4.


Objective: To define various Descemet graft unfolding techniques in Descemet membrane endothelial keratoplasty.

Methods: In a retrospective analysis, the surgical videos of 100 consecutive Descemet membrane endothelial keratoplasty cases with at least 6 months of follow-up were evaluated and categorized. The Descemet graft unfolding methods were categorized into 4 basic techniques and 3 auxiliary techniques.

Results: All Descemet membrane endothelial keratoplasty surgical procedures could be completed using (a combination of) 4 Descemet graft unfolding techniques: (1) standardized no-touch graft unfolding using a double roll, (2) carpet unrolling while fixating 1 graft edge (Dirisamer technique), (3) small air bubble-assisted unrolling (Dapena maneuver), (4) the single sliding cannula maneuver. Additional maneuvers included turning over the graft when oriented upside down (flushing); manual graft centration with a cannula; and bubble bumping to unfold peripheral inward folds. In 73% of surgical procedures, technique 1 was used, while a combination of techniques was used in 44% and auxiliary techniques in 62%. None of the techniques showed a correlation with the best-corrected visual acuity, endothelial cell density, or postoperative complication rate (P > .10).

Conclusions: Descemet membrane endothelial keratoplasty may be further facilitated by using controlled techniques for unfolding the Descemet graft inside the recipient anterior chamber, either as stand-alone techniques or used in various combinations.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Anterior Chamber / surgery*
  • Cell Count
  • Corneal Endothelial Cell Loss / pathology
  • Descemet Stripping Endothelial Keratoplasty / methods*
  • Endothelium, Corneal / transplantation*
  • Female
  • Fuchs' Endothelial Dystrophy / surgery*
  • Humans
  • Male
  • Organ Culture Techniques
  • Postoperative Complications
  • Retrospective Studies
  • Tissue Donors
  • Video Recording
  • Visual Acuity / physiology