Anthony Aldave, M.D. - Perfect Your DMEK with Pre-Loaded DMEK in a Geuder Glass Cannula скачать в хорошем качестве

Anthony Aldave, M.D. - Perfect Your DMEK with Pre-Loaded DMEK in a Geuder Glass Cannula

DMEK Unfolding Made Practical — Insertion, Orientation & Unfolding Maneuvers (Live Demo + Tips) This surgical teaching video focuses on the most anxiety-provoking part of DMEK: getting the graft unfolded and centered. Using Pre-loaded DMEK tissue in a Geuder Glass Cannula, the surgeon walks through insertion, orientation checks, and a toolbox of external/internal maneuvers for fast, controlled unfolding—then finishes with air-fill and early post-op management pearls. WHAT YOU’LL LEARN • Insertion setup: pre-loaded DMEK in Geuder cannula, 5 cc (or 3 cc) BSS syringe, petri dish technique, flushing Optisol with BSS. • Incisions & chamber: ~2.4 mm main incision, radial 1.0 mm paracenteses, AC maintainer considerations, avoiding an over-deep AC. • Orientation checks: “double scroll” strategy in the cannula, rotation test, blue-cannula sign, double-line light reflex, slit-beam & chandelier tips, and when intra-op OCT is a difference-maker. • Flip an inverted graft: create a gentle rotational current (short bursts above/below the graft) to flip safely. • Unfolding maneuvers (mix & match): – External: tapping along the long axis, “press-and-release,” paracentesis burp. – Internal: targeted fluid pulses, controlled chamber shallowing, direct two-cannula manipulation (Dirisamer), selective air only in tough deep-chamber/tight-scroll cases. • Work the configuration you see: double scroll, simple fold, edge fold, scroll, taco, bouquet, even “origami”—with specific tactics for each. • Bubble & finish: deliberate central air injection (1 cc syringe ~0.1 cc air), avoid graft displacement, hydrate for a firm 10-min air fill, then reduce bubble so it doesn’t cover the inferior PI. PEARLS & PITFALLS • Take the extra seconds to ensure a double-scroll, correctly oriented in the cannula—often yields a 5–10-second in-eye unfold. • Don’t over-pressurize the AC during insertion/withdrawal to prevent expulsion. • For deep chambers (post-vitrectomy/high myopes), adjust strategy: chamber control first, then unfold. • Unfolding = continuous re-center + unfold cycles; tap at the apex of a fold to drive opening and re-centering. POST-OP SNAPSHOT (as described) • Firm air fill x10 min, then reduce to keep the inferior PI patent. • Typical graft diameter ~7.75 mm (modulate based on pathology/prior DSAEK ring). • Steroid taper (e.g., pred acetate) and fluoroquinolone per standard protocol; long-term low-dose steroid to lower rejection risk. • Positioning: flat day-of, then partial supine next day; routine day-1 and week-1 checks. DISCLOSURE The presenting surgeon discloses a consulting relationship with CorneaGen. FOR TRAINED PROFESSIONALS Educational content intended for ophthalmic surgeons. Always follow your institution’s protocols and the official IFU. #DMEK #CornealTransplant #Ophthalmology #Geuder #EndothelialKeratoplasty #CorneaGen #Keratoplasty #EyeSurgery #AnteriorSegment