Shifting bubble-guided sutureless technique for performing descemetorhexis for retained Descemet’s membrane after penetrating keratoplasty
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We describe the use of anterior segment optical coherence tomography in the diagnosis of inadvertent retention of Descemet’s membrane (DM) after penetrating keratoplasty, and a novel technique for its removal in a case of congenital hereditary endothelial dystrophy. In this technique, we use a modification of the shifting bubble technique, commonly used in deep anterior lamellar keratoplasty where a viscocohesive ophthalmic viscosurgical device is injected into the false anterior chamber which causes migration of the central air bubble placed in the anterior chamber peripherally and helps in confirming the correct space. The DM is then peeled in a circular fashion with the help of 23-G vitreoretinal micro forceps.
KeywordsRetained Descemet’s membrane 23-G vitreoretinal micro forceps Congenital hereditary endothelial dystrophy Shifting bubble technique
The article was not presented in any meeting. The authors did not receive any financial support from any public or private source. The authors have no financial or proprietary interest in a product, method, or material described herein.
A limbal paracentesis is first made. Trypan blue dye is injected in the supernumerary space to stain the DM. It is then flushed with BSS. Healon is then injected in this space and under the slit section of the microscope, the membrane is identified and peeled using end opening micro-vitreoretinal forceps. Healon is removed bimanually from the anterior chamber at the end. (WMV 32959 kb)
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