Salvaging A Ruptured Graft In Descemet's Membrane Endothelial Keratoplasty（Dmek） Surgery By Sequential Implantation And In-Situ Apposition: A Clever Technical Modification
Published 2026 - 44th Congress of the ESCRS
Reference: POCOR094 | Type: Case Report | DOI: 10.82333/nzne-by05
Authors: Dr Ling Li 1 , Dr Chang Liu 1 , Dr Zexia Dou 1 , Dr Jie Bai 1 , Dr Lin Zhao 1 , Dr Shaowei Li* 1
1Beijing Aier-Intech Eye Hospital,Beijing,China
Purpose
To demonstrate an innovative technique for managing an unintended rupture of the DMEK graft into two unequal parts.
Setting
This case report was conducted at the Department of Cornea, Beijing Aier-Intech Eye Hospital China
Report of case
A 36-year-old male with Fuchs' endothelial corneal dystrophy and corneal decompensation in the right eye. Preoperative best-corrected visual acuity was unmeasurable, with a central corneal thickness of 661μm and an endothelial cell density of 462 cells/mm². During graft preparation, the donor tissue accidentally ruptured into two unequal parts (approximately 5/6 and 1/6).
Instead of aborting the procedure, we employed a sequential implantation technique. The larger graft (5/6) was first implanted, positioned, and allowed to adhere for 5 minutes under an air bubble. After partial air removal confirmed its stability, the smaller graft (1/6) was implanted and meticulously manipulated to achieve near-perfect in-situ apposition with the edges of the larger graft. A final air bubble was injected to secure the composite graft.
The surgery was successfully completed. On postoperative 6mon, the patient's corrected visual acuity improved to 0.5, with an intraocular pressure of 12mmHg. Significant corneal clearance and stable graft attachment were observed.
Conclusion/Take home message
Graft rupture during DMEK is not a terminal event. The demonstrated technique of sequential implantation and in-situ apposition is an effective, reliable, and innovative solution that successfully utilizes the ruptured graft, avoids donor tissue waste, and achieves favorable visual outcomes. This technique is worthy of dissemination among corneal surgeons.