Reviewing The Use Of 'No-Touch' Endo-In Dmek In Complex Anterior Chambers
Published 2025 - 43rd Congress of the ESCRS
Reference: PO931 | Type: Poster | DOI: 10.82333/1zag-8t43
Authors: Leonard Goussard Heydenrych* 1 , Eric Abdullayev 2 , Benjamin Lambright 3
1Cornea and External Eye Disease,Port Elizabeth Provincial Hospital, Cape Eye Hospital and University of Cape Town ,Cape Town,South Africa, 2Innovation,Lions World Vision Institute,Tampa,United States, 3Innovation,West Coast Eye Institute,Lecanto,United States
Purpose
A novel device and technique are reviewed when delivering a correctly oriented DMEK graft into complex anterior chambers without direct manipulation.
Setting
All surgeries were performed and recorded at the Cape Eye Hospital in Cape Town, South Africa. Each surgery was reviewed and the time required to unfold the graft completely was calculated as well as the amount of taps required to unfold the graft completely.
Methods
All grafts (n=15) were pre-loaded at the Lions World Vision Institute eye bank (Tampa, USA), and tri-folded with inverted endothelium in a glass cannula. Out of 15 patients – 5 had failed penetrating keratoplasties (PKP); during DMEK, 1 patient received an anterior vitrectomy, 1 patient received an anterior vitrectomy prior and in 1 patient vitreous was managed conservatively; 3 patients required glaucoma shunt trimming and 4 patients had intra-operative floppy iris syndrome. The size of the main incision, number of sutures used, average time to correct graft unfolding, regression of central corneal thickness (CCT) and post-operative endothelial cell densities (ECD) were assessed.
Results
The incision was 3.2-3.5 mm. All grafts were delivered and unfolded independently into the anterior chamber through fluid insertion and were correctly oriented. 3-5 sutures were required to close the wound. The mean graft unfolding time was 32.30 seconds [SD±17.96]. Mean CCT reduced by 225.74 µm (30.11%). All grafts cleared within 4 weeks post-transplant. Mean post-operative visual acuity at last visit improved to 0.67 (decimal) from 0.21 before surgery. Mean ECD at latest visit (3-12 months) post-operative was 1595.53 cells/mm² [SD±591.87] and mean CCT was 523.93 µm [SD ±62.96].
Conclusions
A novel glass carrier allows spontaneous opening of the DMEK graft in the correct orientation and makes unfolding of the DMEK graft predictable in complex anterior chambers.
This technique leads to a predictably near complete unfolding of all DMEK grafts. It is possible to position the graft in a desired location e.g. in anterior chambers with glaucoma drainage devices. With this new device it has become possible to perform DMEK in cases with deep anterior chambers, intra-operative floppy iris syndrome and with glaucoma drainage devices in situ, without significant manipulation of the graft.