Endoilluminator-assisted transcorneal illumination for Descemet membrane endothelial keratoplasty: enhanced intraoperative visualization of the graft in corneal decompensation secondary to pseudophakic bullous keratopathy

J Cataract Refract Surg. 2014 Aug;40(8):1332-6. doi: 10.1016/j.jcrs.2014.06.019.


Compromised visibility is problematic with Descemet membrane endothelial keratoplasty (DMEK), especially in the presence of corneal edema. Visibility may be enhanced by dehydrating the cornea preoperatively and by debriding the epithelium, staining the graft, and using a handheld slitlamp during surgery. Because the DMEK graft is transparent, thin, and flimsy, it is difficult to confirm the position, orientation, and morphology even with a clearer cornea. We describe a technique (endoilluminator-assisted DMEK) for identifying graft orientation and enhancing 3-dimensional depth perception within the anterior chamber of the graft. The technique uses oblique light from the endoilluminator for better visualization. Light reflexes from graft folds and edges aid further. This technique has the advantages of being able to visualize the entire graft even through hazy cornea, providing the surgeon with better comprehension of graft dynamics, morphology, orientation, and positioning. This leads to easier and faster surgery, potentially decreasing graft damage due to excessive fluidics and unnecessary manipulation.

Financial disclosure: No author has a financial or proprietary interest in any material or method mentioned.

MeSH terms

  • Blister / complications
  • Blister / surgery*
  • Cornea / surgery
  • Corneal Diseases / complications
  • Corneal Diseases / surgery*
  • Corneal Edema / etiology
  • Corneal Edema / surgery*
  • Descemet Membrane / pathology*
  • Descemet Stripping Endothelial Keratoplasty / instrumentation
  • Descemet Stripping Endothelial Keratoplasty / methods*
  • Humans
  • Lighting / instrumentation*
  • Monitoring, Intraoperative*
  • Pseudophakia