Reverse big bubble: a new technique for preparing donor tissue of Descemet membrane endothelial keratoplasty

Glued Intrascleral Fixation of Intraocular Lens With Pupilloplasty and Pre-Descemet Endothelial Keratoplasty

“…[19][20][21][22][23][24] In our series, a type-1 bubble was formed in all the cases, and no loss of tissue during the process of creation of bubble was reported both with the adult and infant donor cornea. 6,8,9 During the combined procedure, no difficulty was encountered in unfolding the PDEK graft because the addition of the PDL layer to the Descemet membrane (DM)-endothelium complex provides it with an extra splinting effect.…”

Comparison of Pneumatic Dissection and Forceps Dissection in Descemet Membrane Endothelial Keratoplasty

“…To make the situation more complex, various separation methods have been described, leaving open questions in which aspects one offers advantages or disadvantages over the other. 5,9,10,12 The current study analyzes, for the first time to our knowledge, the differences between forceps and air dissection techniques of DM and intends to give clinical recommendations. A prerequisite for a successful endothelial transplant is a reproducible and minimally traumatic technique to harvest the DM-endothelium complex.…”

“…The major drawback of this approach is that injected air cannot always be controlled, sometimes resulting in DM tears not suitable for transplantation. 12 The purpose of this current study was to compare both techniques in respect to the accuracy of separation of the DM and the differences of endothelial cell integrity after an incubation period of 7 days after preparation. In addition, analyzing the rate of apoptosis of the endothelial cells to evaluate the long-term graft survival depending on the used separation method and the superiority of one over the other was evaluated.…”

Eye Bank–Prepared Femtosecond Laser–Assisted Automated Descemet Membrane Endothelial Grafts

“…Although the use of an air bubble to separate DM is not a novel preparation of DMEK tissue, [26][27][28][29] Agarwal et al argue that bubbling frequently separates anterior to a preDescemet layer or "Dua Layer," 30 which allows for a stiffer graft. Although this histological concept of the cornea requires more investigation, it is clear that the bubbling technique is associated with higher cell death in our and others' hands.…”