Descemet’s membrane endothelial keratoplasty

Boris Malyugin MD, PhD showed delegates at the 21st ESCRS Winter Meeting several videos of very tricky surgical problems he has encountered during Descemet’s membrane endothelial keratoplasty (DMEK) procedures in which the DM transplant became “glued” to the iris. Presenting at the ESCRS/EuCornea Cornea Day in Maastricht, The Netherlands, Dr Malyugin stressed that, although the vast majority of DMEK procedures are uneventful, proper placement of the membrane can encounter several pitfalls. Dr Malyugin, Moscow, Russia, presented videos of two cases. In the first case, the transplant was very strongly adherent to the peripheral anterior surface of the iris, requiring a great deal of manipulation and re-dying of the membrane to maintain visibility of the transplant. Despite this manipulation, endothelial cell count was normal for a transplant at six months after surgery. The second case was complicated by minor iris haemorrhage during surgical iridotomy, which he performs with a bent needle and a Sinskey Hook. The bleeding caused strong adhesion between the iris and DM. “Blood in the anterior chamber acts like a fibrin glue, attaching the DM to the surface of the iris,” said Dr Malyugin. He reminded delegates to be careful with the surgical iridectomy in order to avoid bleeding from the iris, and to completely remove all blood clots before membrane injection. In this case, relieving the adhesion was not possible, and Dr Malyugin realised that the transplant would not survive the manipulation. “As in this case, conversion from DMEK to Descemet's stripping automated endothelial keratoplasty (DSAEK) might sometimes be a good option,” he concluded.