Dmek In Aphakic & Aniridic Eyes. Techniques To Overcome The Absence Of A Surface To Unfold The Graft.

To present our experience in developing techniques to overcome the challenges of DMEK in aphakia & aniridia. We advocate for DMEK for such complex eyes as it has the lowest rejection rate.

Moorfields Eye Hospital. London

We present a case series of aphakia and aniridia that received DMEK. Two techniques were developed. The first technique consisted in employing temporary an ICL to provide a surface fo graft unfolding and a barrier to prevent posterior graft dislocation. Despite successful outcome; immediate removal of the ICL without compromising graft attachment was challenging. The second technique consisted in using a 10/0 prolene suture to create a “safety-net” at the limbus plane over which the graft could be unfolded. This technique was more cost effective and removing the prolene suture did not compromise graft attachment. The safety-net technique could also be performed in cases with almost total aniridia in which an ICL could not be allocated.

8 patients with aphakia and aniridia or large fixed pupils received DMEK grafts. The safety-net technique was employed in the majority of cases (7) and was replicated without major difficulties. Injecting the graft in a slow and controlled manner and in the correct orientation is the key for an easy unfolding. All cases have at least one year follow-up and did not present episodes of rejection. Two cases had previously received DSAEK which failed after 4 and 6 months respectively, and therefore we confirmed that DMEK is the best option for these complex eyes with increased rejection.