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Irrigating oriented cannulas for graft unfolding in Descemet's membrane endothelial keratoplasty

Poster Details

First Author: C.Sarnicola ITALY

Co Author(s):    E. Sarnicola   F. Sabatino   V. Sarnicola              

Abstract Details


To describe a modification of Descemet membrane endothelial keratoplasty (DMEK) in which irrigating oriented cannulas are used for unfolding the endothelium�â�€�“Descemet membrane (EDM).


Ambulatorio di Chirurgia Oculare Santa Lucia (Grosseto, Rome, Naples - Italy)


Retrospective, comparative, non-randomized, interventional case-series including 78 pseudophakic eyes of patients with Fuchs endothelial dystrophy and pseudophakic bullous keratopathy who underwent DMEK. All eyes were divided in two groups: those in which tap-techniques only were used to unfold the graft (Tap-techniques DMEK group) and those in which irrigating oriented cannulas were used as a second approach (Cannula DMEK group). Intraocular manipulation time was evaluated in Cannula DMEK group, whereas total graft manipulation time was assessed in both groups. Uncorrected visual acuity (UCVA), best spectacle-corrected visual acuity (BSCVA) and endothelial cell count (ECC) were evaluated at 6 and 12 months postoperatively.


All grafts were clear at 6 and 12 months postoperatively. There was a statistically significant improvement in UCVA and BCVA at 6 and 12 months postoperatively in both groups (P<0.01). Endothelial cell loss (ECL) was 32.14% and 32.10% at 12 months in Cannula and Tap-techniques groups, respectively (P>.05). Total graft manipulation time was 3.67 �Â�± 0.37 min in Cannula Group and was 3.12 �Â�± 0.43 min in Tap-techniques DMEK group (P<0.01), whereas intraocular graft manipulation time was 37.9 �Â�± 1.8 sec. Neither graft failure nor episodes of rejection occurred postoperatively.


Irrigating oriented cannulas are a useful and effective tool to unfold the donor graft during DMEK when tap-techniques result to be difficult, as in case of large DMEK graft or shallow anterior chamber.

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