Techniques, Outcomes, and Complications of Preloaded, Trifolded Descemet Membrane Endothelial Keratoplasty Using the DMEK EndoGlide

Abstract

Purpose: To describe 2 insertion techniques, outcomes, and complications of preloaded, trifolded Descemet membrane endothelial keratoplasty (DMEK) cases using the DMEK EndoGlide inserter.Methods: This retrospective, consecutive case series analyzed the first 35 cases using the DMEK EndoGlide performed between October 2018 and October 2019 at a single center. Preloaded, trifolded DMEK tissues were delivered through a fluid-injected or pull-through technique. To inject the tissue, a burst of fluid was delivered into the lumen of the injector with a second instrument. Postoperatively, best-spectacle corrected visual acuity (BSCVA), pachymetry, graft survival, and complications were assessed.Results: Thirty-five eyes of 29 patients underwent DMEK alone (n = 11), with cataract surgery (n = 21), or with additional surgeries (n = 3). Of these, 19 (54.3%) grafts were injected. Video analysis revealed a median time of 3.5 minutes from graft insertion to opening for gas insertion. Median preoperative BSCVA of 0.398 logMAR improved to 0.097 logMAR (P = 0.02) at 9 months. Median pachymetry decreased from 619 mm to 551 mm (P = 0.03) at 9 months. Median donor endothelial cell count of 2890.5 cells/mm 2 reduced to 2123 cells/mm 2 (26.6% endothelial cell loss; P = 0.008) 6 months postoperatively. One (2.9%) graft failed due to inverted marking at the eye bank and subsequent reverse implantation.Conclusions: Pre-loaded, tri-folded tissues can be implanted with acceptable levels of endothelial cell loss. We describe a no-touch method of injecting pre-loaded, tri-folded tissue and highlight incorrect marking as a potential complication. This may not be identifiable intraoperatively due to lack of scroll formation.

Clinical outcome of Descemet membrane endothelial keratoplasty (DMEK) with imported donor corneas in eyes of Asian patients; endothelium‐in versus endothelium‐out method

“…Glass injectors, such as the Geuder cannulas or modified Jones tubes, are used for scrolled grafts with the endothelium-out method. Clinical studies have also presented acceptable ECL rates in DMEK with the endothelium-in delivery [ 15 , 16 , 43 , 44 ]. In Korea, Geuder cannula is not commercially available.…”

Modified Basket Suture for a Floppy or Irregular Iris in Endothelial Keratoplasty

“…Therefore, when we perform DSAEK, we use a Busin glide to insert the donor cornea, and when we perform DMEK, we use a DMEK EndoGlide (Network Medical Products, North Yorkshire, United Kingdom) with the pull-through technique. 11 In conclusion, we have described the modified safetybasket suture technique for corneal endothelial transplantation. This method is used in patients with a floppy iris or other abnormalities to prevent air in the anterior chamber from straying posterior to the iris during the intraoperative and early postoperative periods and preventing iris-cornea contact in the event that air does migrate posteriorly.…”

“…3 ), and care must be taken to avoid trapping the sutures in the graft–host interface. In addition, because the use of a DSAEK/DMEK inserter is not suitable for preventing straying of the donor corneal graft, 10 , 11 we believe that the pull-through technique 11 , 12 is a suitable method for ensuring that the donor cornea is pulled in toward the cornea above the suture. Therefore, when we perform DSAEK, we use a Busin glide to insert the donor cornea, and when we perform DMEK, we use a DMEK EndoGlide (Network Medical Products, North Yorkshire, United Kingdom) with the pull-through technique.…”

DMEK graft: One size does not fit all

“…Although pre‐loaded DMEK with endothelium outwards seems like a viable option with small sized grafts, it is equally challenging in terms of preparing the pre‐loaded DMEK grafts with endothelium inwards. However, new devices such as DMEK Rapid and Coronet DMEK EndoGlide may be adopted for smaller grafts (Ighani et al, 2021; Parekh et al, 2022a,b; Wojcik et al, 2021).…”

“…The device has been found to be safe with ECL of 28.6% at 6 months (Rickmann et al, 2019; Wojcik et al, 2021). In case of endothelium‐inward, the Coronet DMEK EndoGlide (Network Medical Products, North Yorkshire, UK) has shown a 6‐month ECL of 26.6% (Ighani et al, 2021).…”