Copenhagen 2016 Registration Programme Exhibitor Information Virtual Exhibition Satellite Meetings Glaucoma Day 2016 Hotel Star Alliance

10 - 14 Sept. 2016, Bella Center, Copenhagen, Denmark

This Meeting has been awarded 27 CME credits


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Descemet’s membrane endothelial keratoplasty with stromal support (DMEK-S): anterior approach

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Session Details

Session Title: Presented Poster Session: Surgical Cornea

Session Date/Time: Saturday 10/09/2016 | 15:00-16:30

Paper Time: 15:20

Venue: Poster Village: Pod 3

First Author: : J.Sharp UK

Co Author(s): :    V. Avadhanam   C. Wilde   S. Maharajan        

Abstract Details


DMEK is a well-recognised technique with excellent visual outcomes. However, difficulties with graft preparation, tissue handling, and high detachment rates have prevented widespread adoption. DMEK-S is a modification that retains a supporting rim of stroma. This allows easy graft insertion and unfolding as with DSEK, whilst retaining the excellent visual outcomes of DMEK. Most authors describe injection of air from the endothelial side to form a big bubble to detach stroma from Descemet’s membrane. We used an anterior approach in an attempt to improve rate of bubble formation. We describe this technique and outcomes of an initial 18 cases.


Queen’s Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham, UK.


A Moria ALTK microkeratome system was used to remove 350 microns of anterior stroma. A big bubble was formed within residual stromal bed without removing the donor from the artificial anterior chamber, utilising an anterior approach. Central stroma of approximately five millimeters diameter was removed to expose the predescemetic area. The graft was removed from the artificial anterior chamber and punched from the endothelial side using an 8.75mm Barron donor punch. The graft was mounted on a Busin Glide and pulled through with a suture. We report the attachment rate, complications, and post-operative best corrected visual acuity of consecutive cases.


A big bubble was successfully formed in 17 of 18 cases. Graft attachment rate was 7 of 18 (39%) at first attempt. The mean follow-up time was 1 year 10 months (range one week to five years). Two primary failures occurred, one of which was associated with a break in Descemet’s membrane and a post-operative presumed viral keratitis. Five other grafts failed or rejected at a mean time of 2 years and 2 months. Best corrected visual acuity of grafts without primary failure was 6/9 or better in 11 of 16 cases.


The anterior approach for bubble formation confers the advantages of DMEK-S without the need to remount the tissue as has been described by earlier authors. If the bubble fails to form, as happened in one case, the tissue can still be used as a DSEK. In the last 5 cases (with the use of venting incisions) there was one detachment. The learning curve of this particular modification of the DMEK-S technique suggests that further experience could yield acceptable results with a good combination of handling qualities, visual benefit and attachment rate.

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