Peter Szurman1,2, Kai Januschowski3,4, Annekatrin Rickmann3, Lara-Jil Damm3, Karl Thomas Boden3, Natalia Opitz3. 1. Knappschaft Eye Clinic Sulzbach, Knappschaft Hospital Saar, An der Klinik 10, 66280, Sulzbach/Saar, Germany. Peter.Szurman@kksaar.de. 2. Centre for Ophthalmology, University Eye Clinic Tuebingen, Tuebingen, Germany. Peter.Szurman@kksaar.de. 3. Knappschaft Eye Clinic Sulzbach, Knappschaft Hospital Saar, An der Klinik 10, 66280, Sulzbach/Saar, Germany. 4. Centre for Ophthalmology, University Eye Clinic Tuebingen, Tuebingen, Germany.
Abstract
PURPOSE: Descemet endothelial keratoplasty (DMEK) has replaced penetrating keratoplasty in many cases of endothelial cell disorders. While DMEK has been greatly improved by the introduction of no-touch injection cartridges, the tear-free preparation of the delicate Descemet's membrane (DM) remains a critical step. We present a novel liquid bubble dissection technique for DM preparation that could offer several advantages. METHODS: After identification of the iris base, a sharp dissection until Schwalbe's line was performed. Then, a narrow tunnel was created with a blunt spatula using a tangential dissection technique. After the tunnel was created, the liquid bubble dissection was performed. The complete detachment process took only a few seconds after a successful preparation of the tunnel in the correct plane between the DM and corneal stroma. RESULTS: Between February and September 2015, we consecutively performed 86 DMEK lenticule preparations using the liquid bubble technique. The preparation time until complete detachment was about 3 min (mean 194 ± 20 s). Ninety-two percent of preparations were completely uncomplicated; the total success rate was 99 %. One graft could not be used for transplantation because of a central tear. The graft failure rate was 1.16 %, similar to other authors. CONCLUSIONS: The presented novel liquid bubble technique is easy, can be learned and performed rapidly, is highly reproducible in a standardized fashion with minor tissue manipulation (no touch) and, with a low rate of graft preparation failure, necessitates no special equipment and allows for a simultaneous and selective staining of the stromal side of DM, thus avoiding direct contact.
PURPOSE: Descemet endothelial keratoplasty (DMEK) has replaced penetrating keratoplasty in many cases of endothelial cell disorders. While DMEK has been greatly improved by the introduction of no-touch injection cartridges, the tear-free preparation of the delicate Descemet's membrane (DM) remains a critical step. We present a novel liquid bubble dissection technique for DM preparation that could offer several advantages. METHODS: After identification of the iris base, a sharp dissection until Schwalbe's line was performed. Then, a narrow tunnel was created with a blunt spatula using a tangential dissection technique. After the tunnel was created, the liquid bubble dissection was performed. The complete detachment process took only a few seconds after a successful preparation of the tunnel in the correct plane between the DM and corneal stroma. RESULTS: Between February and September 2015, we consecutively performed 86 DMEK lenticule preparations using the liquid bubble technique. The preparation time until complete detachment was about 3 min (mean 194 ± 20 s). Ninety-two percent of preparations were completely uncomplicated; the total success rate was 99 %. One graft could not be used for transplantation because of a central tear. The graft failure rate was 1.16 %, similar to other authors. CONCLUSIONS: The presented novel liquid bubble technique is easy, can be learned and performed rapidly, is highly reproducible in a standardized fashion with minor tissue manipulation (no touch) and, with a low rate of graft preparation failure, necessitates no special equipment and allows for a simultaneous and selective staining of the stromal side of DM, thus avoiding direct contact.
Authors: Friedrich E Kruse; Kathrin Laaser; Claus Cursiefen; Ludwig M Heindl; Ursula Schlötzer-Schrehardt; Stephan Riss; Björn O Bachmann Journal: Cornea Date: 2011-05 Impact factor: 2.651
Authors: Mark A Greiner; Jordan J Rixen; Michael D Wagoner; Gregory A Schmidt; Christopher G Stoeger; Michael D Straiko; M Bridget Zimmerman; Anna S Kitzmann; Kenneth M Goins Journal: Cornea Date: 2014-11 Impact factor: 2.651
Authors: Annekatrin Rickmann; Karl Boden; André M Trouvain; Lisa J Müller; Catheline Bocqué; Sebastian Thaler; Peter Szurman Journal: Int Ophthalmol Date: 2021-10-31 Impact factor: 2.031
Authors: Annekatrin Rickmann; Karl Boden; Silke Wahl; Andre Trouvain; Andre Schulz; Peter Szurman Journal: Int Ophthalmol Date: 2021-10-21 Impact factor: 2.031