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Enhanced donor preparation during Descemet membrane endothelial keratoplasty

A reason to rejoice!

Agarwal, Rinky; Sharma, Namrata

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Indian Journal of Ophthalmology: June 2021 - Volume 69 - Issue 6 - p 1613
doi: 10.4103/ijo.IJO_230_21
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Descemet membrane endothelial keratoplasty (DMEK) involves the replacement of the pathogenic host endothelium by donor descemet-endothelium complex (DEC). Donor tissue preparation and manipulation is particularly challenging in DMEK due to the thin nature of the graft. Different methods of donor preparation include manual stripping, pneumatic dissection and hydro-dissection.[1] Of these, manual stripping is a commonly employed technique due to its high success rate and minimally traumatizing nature. It involves creating an initial peripheral break in the donor DEC subsequently followed by peeling of the DEC using a nontraumatic forceps. The authors presently describe a novel LED-light-based device that is expected to aid in manual donor preparation for DMEK, thereby preventing inadvertent donor tissue loss.[2]

The peripherally situated LED lights in the novel device ensure diffuse illumination of the donor besides avoiding a dazzling light effect encountered with a conventional ophthalmic microscope. This simulates retroillumination from an ophthalmic microscope where the light is reflected internally from the tissues rather than being extrinsically shone on them. The illuminated donor tissue now becomes easy to manipulate as the LED light highlights the edge of separation, and any areas of microadhesions. A similar visualization of anatomic details can also be facilitated by real-time optical coherence tomography-guided imaging of the donor.[3]

While the retroillumination mode of light has been well utilized for identifying intraoperative lens capsule tears, and descemet membrane tears and tags during anterior segment surgeries, combining this mode of light production with microscopic visualization for donor preparation during DMEK is quite a unique amalgamation. The light produced can also be compared to the light emanating from an endoilluminator, an extra advantage being both the hands of the surgeon remaining free for donor manipulation.

The device is expected to not only guide the novice corneal surgeons towards successful donor preparation but also enhance the supply of pre-stripped tissues by eye-bank technicians. While, the re-usable nature of the device and its amalgamation with routine ophthalmic microscope favors cost-effectiveness without breach of surgical sterility, the global availability of the instrument, its initial cost and shelf-life may determine its world-wide acceptance. Additionally, appropriate disinfection and sterilization measures are mandatory for the device to prevent cross-infections.

1. Birbal RS, Sikder S, Lie JT, Groeneveld-van Beek EA, Oellerich S, Melles GRJ. Donor tissue preparation for descemet membrane endothelial keratoplasty: An updated review Cornea. 2018;37:128–35
2. Fogla R. A novel device to visualize Descemet membrane during donor preparation for Descemet membrane endothelial keratoplasty Indian J Ophthalmol. 2021;69:1609–13
3. Sharma N, Priyadarshini K, Agarwal R, Bafna R, Nagpal R, Sinha R, et al Role of Microscope-Intraoperative Optical Coherence Tomography in Pediatric Keratoplasty: AComparative Study Am J Ophthalmol. 2021;221:190–8
© 2021 Indian Journal of Ophthalmology | Published by Wolters Kluwer – Medknow