Novel liquid bubble dissection technique for DMEK lenticule preparation.

Abstract

Descemet endothelial keratoplasty (DMEK) has replaced penetrating keratoplasty in many cases of endothelial cell disorders. While DMEK has been greatly improved by the introduction of no-touch injection cartridges, the tear-free preparation of the delicate Descemet's membrane (DM) remains a critical step. We present a novel liquid bubble dissection technique for DM preparation that could offer several advantages. After identification of the iris base, a sharp dissection until Schwalbe's line was performed. Then, a narrow tunnel was created with a blunt spatula using a tangential dissection technique. After the tunnel was created, the liquid bubble dissection was performed. The complete detachment process took only a few seconds after a successful preparation of the tunnel in the correct plane between the DM and corneal stroma. Between February and September 2015, we consecutively performed 86 DMEK lenticule preparations using the liquid bubble technique. The preparation time until complete detachment was about 3min (mean 194 ± 20s). Ninety-two percent of preparations were completely uncomplicated; the total success rate was 99%. One graft could not be used for transplantation because of a central tear. The graft failure rate was 1.16%, similar to other authors. The presented novel liquid bubble technique is easy, can be learned and performed rapidly, is highly reproducible in a standardized fashion with minor tissue manipulation (no touch) and, with a low rate of graft preparation failure, necessitates no special equipment and allows for a simultaneous and selective staining of the stromal side of DM, thus avoiding direct contact.