The Descemet Membrane Endothelial Keratoplasty (DMEK) “Wave Maneuver”
A novel technique for Descemet membrane endothelial keratoplasty (DMEK) graft handling and centration without the endothelium touching the posterior part of the anterior chamber (AC), is presented here. It is particularly suitable for vitrectomized eyes, deep AC, and AC intraocular lenses (ACIOLs),...
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| Format: | Article |
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MDPI AG
2022-09-01
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| Series: | Journal of Clinical Medicine |
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| Online Access: | https://www.mdpi.com/2077-0383/11/18/5260 |
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| author | Itay Lavy Nir Erdinest Ayala Katzir Naomi London Eleanor Ngwe Nche David Smadja |
| author_facet | Itay Lavy Nir Erdinest Ayala Katzir Naomi London Eleanor Ngwe Nche David Smadja |
| author_sort | Itay Lavy |
| collection | DOAJ |
| description | A novel technique for Descemet membrane endothelial keratoplasty (DMEK) graft handling and centration without the endothelium touching the posterior part of the anterior chamber (AC), is presented here. It is particularly suitable for vitrectomized eyes, deep AC, and AC intraocular lenses (ACIOLs), potentially reducing surgery time and endothelial cell loss during surgery. This retrospective interventional case series includes 27 eyes with complex ocular pathology. All utilized a “Wave maneuver” to center an early elevated graft without completing graft centration on the bottom of the AC. Successful graft attachment and centration were evaluated intra and post-operatively. Best-corrected visual acuity (BCVA), central corneal thickness (CCT), and donor endothelial cell density (ECD) were measured pre-operatively, and three and six months post-operatively. DMEK grafts were successfully attached and centered in all cases. No maneuver-related complications were observed intraoperatively. BCVA improved from a pre-operative 0.2 ± 0.63, to 0.43 ± 0.49 and 0.76 ± 0.51 at the three- and six-month follow-ups, respectively (<i>p</i> < 0.01). CCT decreased from a pre-operative 742 ± 118, to 546 ± 87 and 512 ± 67 at three and six months, respectively (<i>p</i> < 0.01). ECD decreased from 2878 ± 419 cells/mm<sup>2</sup> to 1153 ± 466 cells/mm<sup>2</sup> at three and six months, respectively (<i>p</i> < 0.01). The “Wave maneuver” may be very beneficial in DMEK cases where the AC is either very deep or the bottom of the AC is compromised. The “Wave maneuver” learning curve was brief. |
| first_indexed | 2024-03-09T23:38:15Z |
| format | Article |
| id | doaj.art-abed6fee5bb14a49a6f37c7bf13c1f7f |
| institution | Directory Open Access Journal |
| issn | 2077-0383 |
| language | English |
| last_indexed | 2024-03-09T23:38:15Z |
| publishDate | 2022-09-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Journal of Clinical Medicine |
| spelling | doaj.art-abed6fee5bb14a49a6f37c7bf13c1f7f2023-11-23T16:57:40ZengMDPI AGJournal of Clinical Medicine2077-03832022-09-011118526010.3390/jcm11185260The Descemet Membrane Endothelial Keratoplasty (DMEK) “Wave Maneuver”Itay Lavy0Nir Erdinest1Ayala Katzir2Naomi London3Eleanor Ngwe Nche4David Smadja5Department of Ophthalmology, Hadassah-Hebrew University Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem 91905, IsraelDepartment of Ophthalmology, Hadassah-Hebrew University Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem 91905, IsraelDepartment of Ophthalmology, Hadassah-Hebrew University Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem 91905, IsraelPrivate Practice, Jerusalem 9422805, IsraelDepartment of Ophthalmology, Hadassah-Hebrew University Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem 91905, IsraelDepartment of Ophthalmology, Hadassah-Hebrew University Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem 91905, IsraelA novel technique for Descemet membrane endothelial keratoplasty (DMEK) graft handling and centration without the endothelium touching the posterior part of the anterior chamber (AC), is presented here. It is particularly suitable for vitrectomized eyes, deep AC, and AC intraocular lenses (ACIOLs), potentially reducing surgery time and endothelial cell loss during surgery. This retrospective interventional case series includes 27 eyes with complex ocular pathology. All utilized a “Wave maneuver” to center an early elevated graft without completing graft centration on the bottom of the AC. Successful graft attachment and centration were evaluated intra and post-operatively. Best-corrected visual acuity (BCVA), central corneal thickness (CCT), and donor endothelial cell density (ECD) were measured pre-operatively, and three and six months post-operatively. DMEK grafts were successfully attached and centered in all cases. No maneuver-related complications were observed intraoperatively. BCVA improved from a pre-operative 0.2 ± 0.63, to 0.43 ± 0.49 and 0.76 ± 0.51 at the three- and six-month follow-ups, respectively (<i>p</i> < 0.01). CCT decreased from a pre-operative 742 ± 118, to 546 ± 87 and 512 ± 67 at three and six months, respectively (<i>p</i> < 0.01). ECD decreased from 2878 ± 419 cells/mm<sup>2</sup> to 1153 ± 466 cells/mm<sup>2</sup> at three and six months, respectively (<i>p</i> < 0.01). The “Wave maneuver” may be very beneficial in DMEK cases where the AC is either very deep or the bottom of the AC is compromised. The “Wave maneuver” learning curve was brief.https://www.mdpi.com/2077-0383/11/18/5260corneal transplantationDescemet membrane endothelial keratoplastyDMEKgraft unfoldingDescemet membrane |
| spellingShingle | Itay Lavy Nir Erdinest Ayala Katzir Naomi London Eleanor Ngwe Nche David Smadja The Descemet Membrane Endothelial Keratoplasty (DMEK) “Wave Maneuver” Journal of Clinical Medicine corneal transplantation Descemet membrane endothelial keratoplasty DMEK graft unfolding Descemet membrane |
| title | The Descemet Membrane Endothelial Keratoplasty (DMEK) “Wave Maneuver” |
| title_full | The Descemet Membrane Endothelial Keratoplasty (DMEK) “Wave Maneuver” |
| title_fullStr | The Descemet Membrane Endothelial Keratoplasty (DMEK) “Wave Maneuver” |
| title_full_unstemmed | The Descemet Membrane Endothelial Keratoplasty (DMEK) “Wave Maneuver” |
| title_short | The Descemet Membrane Endothelial Keratoplasty (DMEK) “Wave Maneuver” |
| title_sort | descemet membrane endothelial keratoplasty dmek wave maneuver |
| topic | corneal transplantation Descemet membrane endothelial keratoplasty DMEK graft unfolding Descemet membrane |
| url | https://www.mdpi.com/2077-0383/11/18/5260 |
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