Purpose: Descemet endothelial keratoplasty (DMEK) has replaced penetrating keratoplasty in many cases of endothelial cell disorders. While DMEK has been greatly improved by the introduction of no-touch injection cartridges, the tear-free preparation of the delicate Descemet's membrane (DM) remains a critical step. We present a novel liquid bubble dissection technique for DM preparation that could offer several advantages.
Methods: After identification of the iris base, a sharp dissection until Schwalbe's line was performed. Then, a narrow tunnel was created with a blunt spatula using a tangential dissection technique. After the tunnel was created, the liquid bubble dissection was performed. The complete detachment process took only a few seconds after a successful preparation of the tunnel in the correct plane between the DM and corneal stroma.
Results: Between February and September 2015, we consecutively performed 86 DMEK lenticule preparations using the liquid bubble technique. The preparation time until complete detachment was about 3 min (mean 194 ± 20 s). Ninety-two percent of preparations were completely uncomplicated; the total success rate was 99 %. One graft could not be used for transplantation because of a central tear. The graft failure rate was 1.16 %, similar to other authors.
Conclusions: The presented novel liquid bubble technique is easy, can be learned and performed rapidly, is highly reproducible in a standardized fashion with minor tissue manipulation (no touch) and, with a low rate of graft preparation failure, necessitates no special equipment and allows for a simultaneous and selective staining of the stromal side of DM, thus avoiding direct contact.
Keywords: DMEK; Descemet membrane endothelial keratoplasty; Dissection; Lamellar keratoplasty; Liquid bubble; Preparation.