title: A simple rescue maneuver for unfolding and centering a tightly rolled graft in Descemet membrane endothelial keratoplasty.
abstract: A 74-year-old man underwent Descemet membrane endothelial keratoplasty (DMEK) for endothelial decompensation due to Fuchs endothelial dystrophy. After descemetorhexis, the DMEK graft was inserted into the anterior chamber. However, unfolding of the graft was not possible as the graft was very tightly rolled together and the anterior chamber deep. After placing a 30G-cannula connected to an air-filled syringe inside the roll's lumen, a small air bubble was injected, which allowed the roll to open up, until it assumed a "taco" configuration around the bubble. Then, the graft was centered by pressing the posterior part of the roll against, and sweeping it over the iris. In the present case a "tight" DMEK roll was successfully unfolded by injection of a single air bubble into the roll's lumen and centered by a "sweeping" the partialy unfolded graft over the iris. This technique allowed a controlled unfolding and centering of the DMEK graft with limited trauma to the donor endothelium and may be applied in cases where other less traumatic maneuvers are not successful.
authors.affiliation: Department of Ophthalmology, Philipps University, Marburg, Germany ; First Department of Ophthalmology, University of Athens, Medical School of Athens, Athens, Greece.
authors.forename: Konstantinos
authors.initials: K
authors.lastname: Droutsas
authors.affiliation: Department of Ophthalmology, Philipps University, Marburg, Germany.
authors.forename: Thomas
authors.initials: T
authors.lastname: Bertelmann
authors.affiliation: Department of Ophthalmology, Philipps University, Marburg, Germany.
authors.forename: Frank M
authors.initials: FM
authors.lastname: Schroeder
authors.affiliation: First Department of Ophthalmology, University of Athens, Medical School of Athens, Athens, Greece.
authors.forename: Dimitrios
authors.initials: D
authors.lastname: Papaconstantinou
authors.affiliation: Department of Ophthalmology, Philipps University, Marburg, Germany.
authors.forename: Walter
authors.initials: W
authors.lastname: Sekundo
keywords: Fuchs endothelial dystrophy; endothelial keratoplasty; surgical technique