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Technique to 'F' mark DMEK graft

Poster Details

First Author: P.Viola ITALY

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Abstract Details


Preparation, management and correct orientation of the donor graft are issues that have a part in preventing the wide spread of DMEK surgery. We describe a simple technique to draw an F on the donor graft during preparation on the artificial anterior chamber using a flat spatula painted in gentian violet.


From February to July 2014, 16 eyes of 16 patients with Fuchs’s dystrophy underwent to DMEK surgery. 6 with Muraine’s technique (group A) and 10 with our marking addition technique (group B).


We propose to slide a flat spatula, painted in gentian violet, on the stroma underlying the folded graft which will generate a straight violet line printed on the stroma which will transfer by contact the color as the spatula is removed. Repeat three times this maneuver in order to have an inverted “F” letter painted on graft descemetic side. Follow up examination were permormed at month 1,3 and 6. Early complication such as graft detachment or failure to restore clear cornea and endothelial cell count were performed at every visit. There were no statistical differences in endothelial cell loss percentages at months 6 between the two groups. We had 2 primary graft failure in group A (upside-down graft) and no graft failure in group B. No statistical differences in re-bubbling rate between the two groups.


Many other technique have been used to visualize the proper orientation of the graft such as: shape-cutting the edge of the lamella, handheld slit beam and E-DMEK. The one we’re proposing it’s a DSAEK style technique which is diffusely used and therefore more familiar to the vast majority of corneal surgeon. According to these preliminary results this is an easy and safe technique to unequivocally judge the correct orientation of the graft. This marking technique will help in saving corneas even for a beginner DMEK surgeon.



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