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Double-Line Reflection Pattern as a Simple Method to Determine Graft Orientation of Descemet Membrane Endothelial Keratoplasty

Berrospi, Rubén D., MD*,†,‡; Galvis, Virgilio, MD, PhD*,†,‡; Bhogal, Maninder, MD§,¶; Tello, Alejandro, MD, PhD*,†,‡

doi: 10.1097/ICO.0000000000001889

Purpose: To describe a simple finding, consisting of a double-line reflection from the graft inside the anterior chamber, that can be used to determine the correct donor tissue orientation in Descemet membrane endothelial keratoplasty: which we would like to call Berrospi's sign.

Methods: Evaluation of the presence of linear reflection from the donor tissue when implanted in the anterior chamber.

Results: A distinctive double-line reflection pattern was identified when careful observation of the curls of the scroll was performed under the surgical microscope, which was a confirmatory sign that the graft was in the correct position.

Conclusions: This method of confirming correct graft orientation requires no additional procedures, equipment, or manipulation of the donor tissue and can be used in conjunction with other marking methods already described.

*Centro Oftalmológico Virgilio Galvis, Floridablanca, Colombia;

Universidad Autónoma de Bucaramanga UNAB, Department of Ophthalmology, Bucaramanga, Colombia;

Fundación Oftalmológica de Santander FOSCAL, Department of Ophthalmology, Floridablanca, Colombia;

§St Thomas' Hospital, Department of Ophthalmology, London, United Kingdom; and

Institute of Ophthalmology, University College London, London, United Kingdom.

Correspondence: Alejandro Tello, MD, Centro Oftalmológico Virgilio Galvis, Centro Medico Ardila Lulle, Torre A, Piso 3, Modulo 7. Floridablanca, Santander, Colombia (e-mail:

The authors have no funding or conflicts of interest to disclose.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Web site (

All the authors actively participated in the writing of this manuscript.

Received November 18, 2018

Received in revised form December 20, 2018

Accepted December 23, 2018

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