Novel Maneuver Facilitating Descemet Membrane Unfolding in the Anterior Chamber

Purpose: To describe a new technique for unfolding of the Descemet membrane (DM) during Descemet membrane endothelial keratoplasty. Methods: DM and endothelium were stripped from donor corneas submerged in corneal storage solution. Donor DM diameters were 8.5 mm. The central 8 mm of DM was stripped from the recipient cornea. After staining with trypan blue to improve visualization, donor DM was inserted through a 2.75-mm incision. Unfolding was achieved with simultaneous digital pressure in the equatorial region and tapping of the corneal surface. This technique was performed in Descemet membrane endothelial keratoplasty patients with Fuchs endothelial dystrophy (n = 6) and bullous keratopathy (n = 4). Results: In all cases, a fast attachment of the DM was achieved. The recurling was successfully hindered because of the simultaneous equatorial pressurization and induced fluid currents inside the anterior chamber by appropriate corneal tapping. In all cases, a rapid corneal clearance was achieved with significantly increased visual acuity (logarithm of the minimal angle of resolution visual acuity preoperative = 0.90, logarithm of the minimal angle of resolution visual acuity final assessment = 0.19, P < 0.001; follow-up 14 +/- 5 weeks). Conclusion: Simultaneous digital pressure with corneal tapping is a helpful maneuver to unfold the DM inside the anterior chamber. This technique may reduce the need for unnecessary instrumental and noninstrumental manipulation of the graft.