ESCRS - FP31.04 - Correction Of Upside-Down Dmek Graft Using Fluid Wave Dynamics In Combined Phaco-Dmek Surgery: A Novel Approach

Correction Of Upside-Down Dmek Graft Using Fluid Wave Dynamics In Combined Phaco-Dmek Surgery: A Novel Approach

Published 2025 - 43rd Congress of the ESCRS

Reference: FP31.04 | Type: Free paper | DOI: 10.82333/3w0q-t277

Authors: Ilyana Ismael Trias* 1 , Guillermo Font Duch 1 , Nuria Burguillos Cabrol 1 , Sergi Morera Cerdan 1 , Aitana Gil Dominguez 1 , Montserrat Lopez Lopez 1 , Núria Planas Domènech 1 , Noemi Barnils Garcia 1 , Silvia Sanz Moreno 1 , Maria Vidal Marti 1 , Juan Lillo Sopena 1 , Jose Maria Caminal Mitjana 1

1Bellvitge University Hospital,L'Hospitalet de Llobregat,Spain

Purpose

To describe a novel technique for correcting an upside-down Descemet’s Membrane Endothelial Keratoplasty (DMEK) graft using continuous fluid injection, creating a controlled vortex for spontaneous graft orientation. This method is demonstrated in the context of combined phacoemulsification and DMEK surgery, optimizing both visual and endothelial outcomes.

Setting

Single-surgeon case performed at University hospital Edouard Herriot - Ophthalmology department , Lyon , France , evaluating the efficacy and reproducibility of this technique in live surgical settings 

Methods

The Patient underwent combined phaco-DMEK surgery. After phacoemulsification and intraocular lens implantation, the DMEK graft was introduced into the anterior chamber.

•A fine-gauge cannula was positioned at the iris plane, delivering a continuous stream of balanced salt solution (BSS).

•The injected fluid induced a circular vortex flow between the graft and cornea, generating rotational forces that facilitated spontaneous realignment of an upside-down graft.

Results

The technique achieved successful graft reorientation of the graft as it showed on the video and confirmed by the use of Intra-operative OCT 

•No additional manipulation was required 

•Postoperative graft adherence successful at Day 1 and at Week 1 and did not need any re-bubbling

•No significant complications related to prolonged fluid injection or concurrent phacoemulsification were observed.

Conclusions

This fluid-induced graft rotation technique provides a minimally invasive, efficient, and reproducible solution for correcting an upside-down DMEK graft, particularly in combined phaco-DMEK procedures. By leveraging anterior chamber fluid dynamics, surgeons can reduce the need for direct graft manipulation, potentially improving endothelial survival and surgical outcomes.

 

Acknowledgment: The author would like to acknowledge Professor Burillon Carole for her mentorship during the fellowship at the University of Lyon 1, France. Special thanks to Dr. Cedric Esminezhad for his assistance during the surgical procedure.