DMEK with young donor (Tight Roll) | Cornea Colours | Season-2 | Episode-7 скачать в хорошем качестве

DMEK with young donor (Tight Roll) | Cornea Colours | Season-2 | Episode-7

𝗗𝗠𝗘𝗞 has become the superior form of endothelial keratoplasty in routine cases of corneal endothelial diseases in many countries worldwide. Although DMEK presents multiple advantages such as less graft rejection and faster visual recovery, but sometimes graft preparation and unfolding become challenging. Successful DMEK surgery depends on various factors, including surgical skill, tissue processing technique, and donor selection criteria. The younger donor corneas may pose a challenge during DMEK surgery due to tighter rolls, Hence, it is essential to describe useful maneuvers in this type of donor graft. Graft orientation during the surgery is the first critical step for a successful outcome, especially when using young donors and tight rolls. So, the double scroll graft should be visually inspected before insertion and set so that the scrolls are facing upward. Shallowing the AC and placing a small bubble between the graft and the iris are strongly recommended maneuvers. Although younger donors have been described as providing safe tissue for DMEK surgery, they represent a surgical challenge as their grafts tend to result in tighter rolls with a longer intraoperative unfolding time. The purpose of this video is to show surgical maneuvers recommended for a successful unfolding of young donors in order to accomplish an uneventful DMEK surgery. Following are the surgical steps for DMEK with tight roll: 𝗗𝗼𝗻𝗼𝗿 𝗣𝗿𝗲𝗽𝗮𝗿𝗮𝘁𝗶𝗼𝗻 𝗣𝗮𝗿𝘁 𝟭 ==================== Donor tissue was partially punched with 10 mm trephine after staining endothelium with trypan blue dye The ledge between DM and stroma was delineated with Sinskey's hook-360 degree The age of the donor tissue was 35 years DM was very gently lifted up at the edges The edges started rolling towards the stromal side, on both sides Full-thickness stromal punch was done with a 3 mm skin biopsy punch Folded DM was rolled back using BSS and merocel sponge There was difficulty in unrolling the graft DM was floated again and the merocel sponge was kept away at the sclerocorneal rim 𝗥𝗲𝗰𝗶𝗽𝗶𝗲𝗻𝘁 𝗣𝗿𝗲𝗽𝗮𝗿𝗮𝘁𝗶𝗼𝗻 ================= Epithelial debridement was done with 15 no. blade 3 side ports were made with MVR blade at 2, 5, and 9 o'clock 2 o'clock side port was made for the AC maintainer Reverse sinskey was inserted through the 9 o'clock side port and descemetorrhexis was done Trypan blue dye was injected to delineate residual DM tags Entry(1-2mm) was made with 2.8 keratome Scoring and scraping of descemet membrane was done Residual DM tags were removed with a single port aspiration cannula Peripheral iridectomy was done at 5 o'clock with a vitrectomy cutter The entry was made with 2.8 keratome ACM was removed and full chamber air bubble was injected Planned graft size was measured with calliper 𝗗𝗼𝗻𝗼𝗿 𝗣𝗿𝗲𝗽𝗮𝗿𝗮𝘁𝗶𝗼𝗻 𝗣𝗮𝗿𝘁 𝟮 =================== Graft placed on the flat side of teflon block with endothelium facing downwards The stromal button was removed The bed was dried with a merocel sponge P mark was made using marker smeared with gentian violet Stromal button was placed back Donor tissue was flipped and placed on the block with endothelium side up Desired partial thickness trephination of donor tissue done and trypan blue was instilled Peripheral rim of the DM was removed with the plain forceps Complete peeling of DM was done Trypan blue dye was instilled and left for 3 minutes BSS was injected drop by drop as DM rolled up It was a TIGHT ROLL The orientation in the injector could not be controlled because of the tight roll 𝗚𝗿𝗮𝗳𝘁 𝗜𝗻𝘀𝗲𝗿𝘁𝗶𝗼𝗻 ============ DM roll injected in correct orientation (empty side of triangle up) in AC Shallowing of the AC aids in unfolding of the graft A shallow anterior chamber throughout the surgery is desirable One end of the graft was stabilized by pin down maneuver of left cannula and uncurled by tapping movements of the other hand Strokes were applied towards the periphery with the cannula to uncurl the DM, while pinning down with the other cannula The graft was centred with tapping movements Full chamber air bubble was injected BCL was placed 𝗗𝗶𝘀𝗰𝗹𝗮𝗶𝗺𝗲𝗿: This video is meant for the education of eye specialist. The treatment should be done by ophthalmologist based on own clinical judgment.