title: Novel maneuver facilitating Descemet membrane unfolding in the anterior chamber.
abstract: OBJECTIVE
  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).
  
  
  CONCLUSIONS
  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.
authors: Department of Ophthalmology, Eberhard-Karls University, Tuebingen, Germany. efdal.yoeruek@med.uni-tuebingen.de
authors: Efdal
authors: E
authors: Yoeruek
authors: Tarek
authors: T
authors: Bayyoud
authors: Johanna
authors: J
authors: Hofmann
authors: Karl-Ulrich
authors: KU
authors: Bartz-Schmidt
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000867:Anterior Chamber / Q000601:surgery*; D003886:Descemet Membrane / Q000601:surgery*; D057111:Descemet Stripping Endothelial Keratoplasty / Q000379:methods*; D005260:Female; D005642:Fuchs' Endothelial Dystrophy / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009924:Organ Culture Techniques; D014019:Tissue Donors; D014792:Visual Acuity / Q000502:physiology