“Safety Net Technique” To Facilitate Dmek Graft Unfolding In Pseudophakic Vitrectomized Eyes With Very Deep Anterior Chambers.

To describe a different approach to perform DMEK in vitrectomized eyes with very deep anterior chambers.

Moorfields Eye Hospital. London. United Kingdom.

Description of 3 cases in which the safety net technique was employed to perform DMEK from 2020 to 2022. The technique consists passing a 10/0 prolene suture at the limbus plane horizontally and vertically before opening the cornea to create a shallow pseudo anterior chamber. Descemetorrhexis is performed under air and the graft is injected in a controlled slow manner in the correct orientation over the net. Unfolding of the graft is then completed easily with gentle bimanual tapping. The follow up period ranged from 6 months to 24 months postoperatively.

Three cases with bullous keratopathy, previous pars plana vitrectomy and posterior chamber scleral sutured IOLs received DMEK with this technique. All cases had previously traumatic aphakia and in all the AC depth was >4mm on OCT. Two cases had previously received penetrating keratoplasty (PK) and one had a partial aniridia. DMEK was successfully performed in all three cases and unfolding of the graft was easily achieved in a very short surgical time.  Rebubbling was only required in one case. Corneal transparency and visual improvement was achieved in all three patients and the graft remained well functioning a the end of the follow-up period. 

The Safety Net Technique is a cost effective technique to facilitate DMEK in eyes with very deep AC in which corneal tapping results difficult. It also minimises surgical unfolding time and therefore endothelial cell loss. Surgical experience in DMEK is essential before starting performing this technique.