A Method to Confirm Correct Orientation of Descemet Membrane During Descemet Membrane Endothelial Keratoplasty

Relationship Between Tissue Unscrolling Time and Endothelial Cell Loss

“…Our group has reported the efficacy and technique of using this method for determining graft orientation, but others have had success with alternative approaches, including asymmetric peripheral scallops, Moutsouri sign, and intraoperative slit lamp and optical coherence tomography. [17][18][19][20] To summarize the surgical technique, a temporal 2.8-mm clear corneal incision was created at the limbus and enlarged as needed up to 3.2 mm to make a snug fit with the modified glass Jones Tube Straiko injector (Gunther Weiss Scientific Glassblowing Co, Portland, OR). Inferior surgical iridotomy was then made with a bimanual scratch-down technique and enlarged with intraocular microscissors.…”

Descemet membrane endothelial keratoplasty

“…Newer dyes such as patent blue and methyl blue, approved for retinal membrane staining, may be safer in terms of corneal endothelial toxicity in vitro 36. Asymmetrical marking of the donor may also be useful for determining the graft orientation after insertion into the eye 38. More importantly, donor preparation may be influenced by donor characteristics.…”

Prevention and Management of Graft Detachment in Descemet Membrane Endothelial Keratoplasty

“…The orientation of the graft can be determined by the Moutsouris sign (see Figure 6 of the article by Dapena et al 5 ) and/or marking the graft. 5,31 We previously described that the use of plastic and/or viscoelastic materials may be avoided in DMEK to minimize the risk of graft detachment. Performing the descemetorhexis under air may have the advantages that remnant host Descemet fragments are more easily identified and that the negative imbibition pressure facilitating graft adherence is better preserved (by avoiding stromal overhydration with the use of balanced salt solution in combination with an anterior chamber maintainer).…”