Official ESCRS | European Society of Cataract & Refractive Surgeons


Inducing a trifold conformation in Descemet’s membrane endothelial keratoplasty (DMEK) using small paired radial incisions

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Session Details

Session Title: Cornea Surgical: Lamellar Corneal Grafts

Session Date/Time: Tuesday 17/09/2019 | 08:30-10:30

Paper Time: 09:12

Venue: Free Paper Forum: Podium 3

First Author: : J.Hou USA

Co Author(s): :    P. Bedard   J. Justin   M. Hansen                       

Abstract Details


To evaluate the efficacy of using small paired radial incisions to induce a favorable trifold conformation in Descemet’s membrane endothelial keratoplasty (DMEK) grafts. To determine optimal parameters for incision length and donor age.


Investigational laboratory study. Department of Ophthalmology & Visual Neurosciences, University of Minnesota, Minneapolis, MN, USA. Lions Gift of Sight Eye Bank, St. Paul, MN, USA.


DMEK grafts were obtained and trephined to 7.75mm. Grafts were then submerged in BSS and allowed to scroll. Afterwards, the grafts were flattened and paired radial incisions with 120o of separation were added. Initial incisions were cut to a length 0.5mm. Subsequently, they were extended to 1.0mm, and then to 1.5mm. After each modification, the grafts were resubmerged in BSS and scrolling pattern (scroll vs trifold) and graft width were evaluated. Changes in graft width and conformation (scroll to trifold) were evaluated across different donor ages and incision lengths to determine optimal parameters for inducing trifolds in DMEK using incisions.


Overall, 14 grafts were included in the study. 71% (10/14) achieved stable trifolds after adding incisions, compared to 0% (0/14) prior. After adding incisions, 100% (10/10) of donor grafts age ≤65 achieved stable trifolds, compared to 0% (0/4) age >65. For grafts age ≤65, 60% (6/10) achieved stable trifolds with incision length ≤0.5mm; 80% (8/10) achieved stable trifolds with incision length ≤1.0mm; and 100% (10/10) achieved stable trifolds with incision length ≤1.5mm. Mean graft width (1499µm) increased with donor age prior to incisions. After incisions, mean graft width (5618µm) was 2.8x higher, but remained stable with donor age.


Compared to a tight scroll, a trifold conformation is more favorable for unfolding DMEK grafts during surgery. Small paired radial incisions can be used to induce a trifold conformation in DMEK grafts age ≤65. Longer incision lengths result in more a consistent trifold conformation. Using small radial incisions to modify DMEK grafts prior to graft insertion, may help simplify DMEK surgery overall.

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