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Management of Descemet Membrane's Folds After Deep Anterior Lamellar Keratoplasty

Descemet Membrane—Tucking Technique

Neri, Alberto, MD, FEBO*; Moramarco, Antonio, MD*; Iovieno, Alfonso, MD, PhD, FRCSC*,†; Fontana, Luigi, MD, PhD*

doi: 10.1097/ICO.0000000000001910

Purpose: To describe a surgical maneuver that allows for correction of central Descemet membrane (DM) folds at the end of a deep anterior lamellar keratoplasty (DALK) procedure. We term the present technique “DM tucking.”

Methods: A blunt tip spatula is introduced vertically into the trephination cut, 90 degrees away from the main direction of the DM folds, and advanced until it touches the host layer. Gentle pressure is applied, resulting in tucking of the redundant host layer toward the periphery. The tucking maneuver is repeated at different clock hours until a regular graft–host interface is obtained.

Results: We applied the present technique to several DALK procedures performed for keratoconus, and found it to be safe and effective.

Conclusions: DALK is the procedure of choice for the surgical treatment of corneal stromal diseases with a healthy endothelium, such as keratoconus. DM folds are a possible complication after DALK in patients with advanced corneal ectasia, arising from the compression of the redundant host DM by the donor graft, once it is sutured to the recipient. DM folds after DALK, when they involve the visual axis, cause permanent visual disturbances DM tucking allows the displacement of the central DM folds toward the graft margin, where they do not affect the patient's quality of vision.

*Ophthalmology Unit, Azienda USL—IRCCS di Reggio Emilia, Reggio Emilia, Italy; and

Department of Ophthalmology and Visual Sciences, University of British Columbia, Vancouver, British Columbia, Canada.

Correspondence: Alberto Neri, MD, FEBO, Ophthalmic Unit, Azienda USL—IRCCS di Reggio Emilia, Viale Risorgimento 80, 42010 Reggio Emilia, Italy (e-mail:

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

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Received December 02, 2018

Received in revised form January 14, 2019

Accepted January 15, 2019

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