Techniques for Graft Visualization and Identification of Graft Orientation: Endoilluminator-Assisted Descemet’s Membrane Endothelial Keratoplasty (E-DMEK) and Others
Descemet’s membrane endothelial keratoplasty (DMEK)  and pre-Descemet’s endothelial keratoplasty  (PDEK) are both techniques that utilize endothelial transplantation with either the Descemet’s membrane (DM) alone or by also including the pre-Descemet’s layer (PDL) . As both these techniques utilize tissue transfer of grafts that are only 15–30 μm thick, there are certain challenges that are specific to both of these. Both these grafts always curl towards the side of the Descemet’s membrane as this structure is elastic in nature. This curling is crucial to identify as the graft needs to be positioned with the curls facing upwards in order to have the endothelial side facing downwards after graft floatation (Fig. 13.1). Difficulties that are often experienced by the surgeon relate to the transparency of the graft under the microscope light making it difficult to visualize the graft and to identify the orientation of the graft with relation to endothelial side. Various techniques have been used to try and identify the graft intraoperatively. The author (SJ) described the endoilluminator-assisted DMEK (E-DMEK  and the E-PDEK  techniques to enhance visualization in DMEK and PDEK, respectively.
KeywordsDepth Perception Corneal Edema Light Probe Endothelial Keratoplasty Gentian Violet
- 4.Jacob S, Agarwal A, Agarwal A, Narasimhan S, Kumar DA, Sivagnanam S. Endoilluminator-assisted transcorneal illumination for Descemet membrane endothelial keratoplasty: enhanced intraoperative visualization of the graft in corneal decompensation secondary to pseudophakic bullous keratopathy. J Cataract Refract Surg. 2014;40(8):1332–6.CrossRefPubMedGoogle Scholar
- 5.Jacob S, Agarwal A, Kumar DA. Endoilluminator-assisted Descemet membrane endothelial keratoplasty and endoilluminator-assisted pre-Descemet endothelial keratoplasty. Clin Ophthalmol. 2015 Nov 16;9:2123-5.Google Scholar
- 7.Inoue T, Oshima Y, Hori Y, Maeda N, Nishida K. Chandelier illumination for use during Descemet Stripping Automated Endothelial keratoplasty in patients with advanced bullous keratopathy. Cornea. 2011;30(Suppl 1):S50–3.Google Scholar
- 8.Yoeruek E, Hofmann J, Bartz-Schmidt KU. Histological and ultrastructural findings of corneal tissue after failed Descemet membrane endothelial keratoplasty. Acta Ophthalmol. 2014;92:e213–6; Dirisamer M, van Dijk K, Dapena I, et al. Prevention and management of graft detachment in descemet membrane endothelial keratoplasty. Arch Ophthalmol. 2012;130:280–91.Google Scholar