Scleral Spurectomy - DMEK Peeling Technique скачать в хорошем качестве

Scleral Spurectomy - DMEK Peeling Technique

0:05 - The scleral spurectomy method was coined by Dr. Mauricio Perez and Dr. Neera Singal, University of Toronto 0:11 - It involves manual dissection of the scleral spur with a toothed forceps. 0:16 - Scleral spurectomy is a helpful step for those having difficulty finding the correct plane of dissection . 0:21 - This dissection is continued 360 degrees. 0:31 - A whitish area will be noted in denuded areas indicating correct dissection. 0:51 - A modified Sloan dissector is then used to lift and separate the edge 360 degrees. 1:00 - A curved non toothed forceps is then used to grab the edge and start peeling. 1:07 - It is important to start the peel in an area without tears. 1:13 - Maintain a horizontal plane close to the endothelium while peeling. 1:18 - Subtle back and forth movement avoids stress lines and prevents tears from forming. 1:23 - Dry with a weckcel and encourage a taco formation so there is room to punch. 1:29 - A 2.0mm dermatology punch is used to create a stromal window. 1:42 - BSS is applied to unfold the graft from the taco formation to mark from other side. 1:47 - Meticulously dry with Weckel to lock the graft in unfolded position and then flip. 2:01 - After flipping continue meticulously drying with Weckcel to allow marking. 2:07 - Mark with unambiguous symbol otherwise you will be confused during surgery. 2:15 - Make sure that you are properly centered and that your mark is included in the trephination. 2:20 - Tap enough to penetrate Descemet 360 degrees but avoid going full thickness. 2:28 - Remove the remnant Descemet surrounding your graft with a capsulorhexis movement. 2:35 - Complete your peeling with the non toothed curved forceps similar to before. 2:40 - Stain your graft for at least two minutes, even more for complex cases. 2:44 - Dry with two Weckcels 180 degrees apart to prevent graft from "flying off". 2:49 - Drops of BSS aimed at graft encourage it to form double scroll formation. 2:45 - Graft is then loaded into the Geuder glass injector.