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Partitioning an Artificial Anterior Chamber With a Latex Diaphragm to Simulate Anterior and Posterior Segment Pressure Dynamics: The “DMEK Practice Stage,” Where Surgeons Can Rehearse the “DMEK Dance”

Sáles, Christopher, S., MD, MPH*,†; Straiko, Michael, D., MD†,‡; Fernandez, Ana, Alzaga, MD*; Odell, Kelly, BS; Dye, Philip, K., CEBT; Tran, Khoa, D., PhD

doi: 10.1097/ICO.0000000000001435
Techniques

Purpose: To present a novel apparatus for simulating the anterior and posterior segment pressure dynamics involved in executing Descemet membrane endothelial keratoplasty (DMEK) surgery when using a chamber-shallowing technique.

Methods: An artificial anterior chamber (AAC), 18-mm trephine, latex glove, two 3-mL syringes, and one donor cornea comprising an intact corneoscleral cap from which a DMEK tissue was peeled and punched are required for the model. After making the corneal incisions with the corneoscleral cap mounted on the AAC in the usual fashion, the corneoscleral cap is remounted onto the dried AAC over an 18-mm latex diaphragm. The space between the latex diaphragm and the cornea is filled with saline to pressurize the anterior chamber, and the posterior segment is pressurized with air from a syringe. The resulting apparatus comprises a posterior segment and anterior chamber that exert pressure on each other by way of a distensible latex diaphragm.

Results: A novice and experienced DMEK surgeon and 2 eye bank technicians were able to assemble the apparatus and perform the routine steps of a DMEK procedure, including maneuvers that require shallowing the anterior chamber and lowering its pressure. Only one cornea was required per apparatus.

Conclusions: We present a novel in vitro model of the human eye that more closely mimics the anterior and posterior segment pressure dynamics of in vivo DMEK surgery than average human and animal cadaveric globes. The model is easy to assemble, inexpensive, and applicable to a range of teaching environments.

*Department of Ophthalmology, Weill Cornell Medical College, New York, NY;

Vision Research Laboratory Lions VisionGift, Portland, OR; and

Cornea Service, Devers Eye Institute, Portland, OR.

Reprints: Christopher S. Sáles, MD, MPH, Department of Ophthalmology, Weill Cornell Medical College, 1305 York Avenue, 12th Floor, New York, NY 10021 (e-mail: css9014@med.cornell.edu).

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 (www.corneajrnl.com).

Received July 23, 2017

Received in revised form September 09, 2017

Accepted September 17, 2017

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