ArticleJournal of ophthalmology2019
How to Avoid an Upside-Down Orientation of the Graft during Descemet Membrane Endothelial Keratoplasty?
Article in Journal of ophthalmology, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 5 papers.
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Who cites it
5 citing papers in PubMed.
- An Optimized Mechanical Peeling Protocol for Mouse Corneal Endothelium.Bioengineering (Basel, Switzerland) · 2026Article
- Avoiding Post-DMEK IOP Elevation: Insights from a Standardized Surgical Approach.Journal of clinical medicine · 2026Article
- Clinical outcomes in imported endothelium-in preloaded vs. surgeon-loaded DMEKs in Asian eyes.Frontiers in medicine · 2025Article
- Automatic evaluation of graft orientation during Descemet membrane endothelial keratoplasty using intraoperative OCT.Biomedical optics express · 2022Article
- Clinical results after single asymmetrical shark fin for graft orientation in DMEK.International ophthalmology · 2022Article
Corrections and comments
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Authors and funding
8 authors.
Funding
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Abstract
purposeIncorrect anterior-posterior orientation of the Descemet endothelial complex (DEC) is one of the causes of failure of Descemet membrane endothelial keratoplasty (DMEK). We evaluated a new marking technique to avoid such a misorientation.
methodA new marking technique of the DEC was evaluated in patients requiring primary DMEK. A Braille-"R"-letter was applied dot by dot onto the stromal surface of the DEC after lifting it by injecting an air-bubble into the interface between the endothelial surface of the partially stripped graft. The positioning of the graft was intraoperatively controlled by an orientation of the Braille-"R"-letter. Laboratory tests were conducted to test the impact of the marking technique on endothelial cell count.
resultsWe included prospectively 37 eyes of 30 patients. Four eyes were phakic and 33 pseudophakic. Five grafts (14%) presented an undifferentiated rolling tendency in the anterior chamber, and evaluation of their positioning was possible due to orientation of the mark alone. In case of an upside-down orientation, grafts were flipped immediately. A correct orientation of the graft was achieved in all cases at the end of the surgery. The endothelial cell loss due to the mark was estimated to be less than 0.3%. At 3- and 6-month follow-ups, the mean best-corrected visual acuity was 0.21 ± 0.15 and 0.15 ± 0.11 logMAR, respectively, and endothelial cell density was 1661 ± 349 and 1618 ± 396 cells/mm
conclusionsTo rely on the natural rolling tendency of the graft alone does not assure its correct positioning in all cases. Creation of the mark with 4 dots punctuated on the air-lifted stromal side of the DEC is a simple and endothelial cell saving marking method to ensure correct orientation of the graft during DMEK.
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Registered trials
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