Novel Technique for Descemet Membrane Remnant Stripping in Hazy Cornea During DSAEK.

Abstract

To describe a novel technique for removal of Descemet membrane (DM) tags or remnants in hazy corneas during Descemet stripping automated endothelial keratoplasty. The DM tags or remnants may be difficult to visualize in the presence of hazy corneas. To identify and remove the residual DM remnants and tags, a crescent knife is introduced into the anterior chamber through the 3.2 mm temporal corneoscleral tunnel and is placed intracamerally, parallel to the iris plane underneath scored DM (which had been previously stained with the trypan blue solution). Under direct illumination from the operating microscope, the crescent blade acts as a light reflector so that the blue DM remnants and tags are highlighted against the silver background of the crescent knife. These tags or remnants may then be identified and then peeled off using intravitreal forceps. The donor lenticule is inserted and air tamponade is used for apposition of the donor lenticule to the recipient host. This technique was used successfully in 10 eyes. No DM tags were present in any of the eyes postoperatively and all the grafts were well apposed. The crescent blade as a reflector is a simple and useful tool to identify trypan blue stained DM remnants or tags in the presence of hazy corneas during endothelial keratoplasty.