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The 'ghost DMEK' technique: peripheral staining of Descemet's membrane endothelial keratoplasty (DMEK) grafts without using trypan blue

Poster Details

First Author: E.Livny ISRAEL

Co Author(s):    I. Bahar   Y. Nahum                 

Abstract Details


To describe a novel graft staining technique for DMEK surgery in which Trypan blue is not used to stain the graft prior to surgery. This novel technique allows for easy recognition of the graft's orientation in the anterior chamber by simple observation, which obviates more complicated or expensive methods used to determine its orientation. Moreover,This technique renders Trypan blue toxicity issues irrelevant


Ophthalmology department at the Rabin Medical Center - a tertiary hospital affiliated to Tel-Aviv University, Israel


Partially pre-stripped grafts were put endothelium-side up on a punch block. The inner part of the trephine knife was marked by gentian-violet marker. During trephination, the graft's borders were stained by gentian-violet, leaving the rest of the graft un-stained. Then, DMEK surgery was performed without staining the grafts with Trypan blue throughout surgery. Grafts unfolding and centration was possible due to its marked borders, and its orientation was easily determined by simple observation due to the contrast between the stained borders to the unstained rest of the graft. So far, 7 DMEK cases were operated by this novel technique


In all cases, graft unfolding and centration in the anterior chamber was feasible without the use of Trypan blue, and in all cases the proper orientation of the graft was apparent by simple observation of its borders, without the necessity of using any other techniques used to determine graft orientation. All cases were successfully concluded with clearing of the operated corneas and with vision improvement


In order to ascertain graft's orientation during DMEK surgery, different maneuvers are implemented such as the "blue cannula tip sign" (Moutsouris sign), use of oblique slit beam by hand-held slit lamp, use of intra-operative AS-OCT or marking an "F" or "S" on the Descemet's side of the graft. The novel technique hereby presented obviates the need for these more complicated or expensive techniques and enables quick and simple recognition of the graft's orientation simply by observing it. Moreover, since Trypan blue is not used during surgery, toxicity issues of Trypan blue stain are irrelevant when applying this technique

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