title: Novel liquid bubble dissection technique for DMEK lenticule preparation.
abstract: OBJECTIVE
  Descemet endothelial keratoplasty (DMEK) has replaced penetrating keratoplasty in many cases of endothelial cell disorders. While DMEK has been greatly improved by the introduction of no-touch injection cartridges, the tear-free preparation of the delicate Descemet's membrane (DM) remains a critical step. We present a novel liquid bubble dissection technique for DM preparation that could offer several advantages.
  
  
  METHODS
  After identification of the iris base, a sharp dissection until Schwalbe's line was performed. Then, a narrow tunnel was created with a blunt spatula using a tangential dissection technique. After the tunnel was created, the liquid bubble dissection was performed. The complete detachment process took only a few seconds after a successful preparation of the tunnel in the correct plane between the DM and corneal stroma.
  
  
  RESULTS
  Between February and September 2015, we consecutively performed 86 DMEK lenticule preparations using the liquid bubble technique. The preparation time until complete detachment was about 3 min (mean 194 ± 20 s). Ninety-two percent of preparations were completely uncomplicated; the total success rate was 99 %. One graft could not be used for transplantation because of a central tear. The graft failure rate was 1.16 %, similar to other authors.
  
  
  CONCLUSIONS
  The presented novel liquid bubble technique is easy, can be learned and performed rapidly, is highly reproducible in a standardized fashion with minor tissue manipulation (no touch) and, with a low rate of graft preparation failure, necessitates no special equipment and allows for a simultaneous and selective staining of the stromal side of DM, thus avoiding direct contact.
authors.affiliation: Knappschaft Eye Clinic Sulzbach, Knappschaft Hospital Saar, An der Klinik 10, 66280, Sulzbach/Saar, Germany. Peter.Szurman@kksaar.de.|Centre for Ophthalmology, University Eye Clinic Tuebingen, Tuebingen, Germany. Peter.Szurman@kksaar.de.
authors.forename: Peter
authors.initials: P
authors.lastname: Szurman
authors.affiliation: Knappschaft Eye Clinic Sulzbach, Knappschaft Hospital Saar, An der Klinik 10, 66280, Sulzbach/Saar, Germany.|Centre for Ophthalmology, University Eye Clinic Tuebingen, Tuebingen, Germany.
authors.forename: Kai
authors.initials: K
authors.lastname: Januschowski
authors.affiliation: Knappschaft Eye Clinic Sulzbach, Knappschaft Hospital Saar, An der Klinik 10, 66280, Sulzbach/Saar, Germany.
authors.forename: Annekatrin
authors.initials: A
authors.lastname: Rickmann
authors.affiliation: Knappschaft Eye Clinic Sulzbach, Knappschaft Hospital Saar, An der Klinik 10, 66280, Sulzbach/Saar, Germany.
authors.forename: Lara-Jil
authors.initials: LJ
authors.lastname: Damm
authors.affiliation: Knappschaft Eye Clinic Sulzbach, Knappschaft Hospital Saar, An der Klinik 10, 66280, Sulzbach/Saar, Germany.
authors.forename: Karl Thomas
authors.initials: KT
authors.lastname: Boden
authors.affiliation: Knappschaft Eye Clinic Sulzbach, Knappschaft Hospital Saar, An der Klinik 10, 66280, Sulzbach/Saar, Germany.
authors.forename: Natalia
authors.initials: N
authors.lastname: Opitz
mesh_terms: D003316:Corneal Diseases / Q000175:diagnosis / Q000601:surgery*; D019781:Corneal Topography; D057111:Descemet Stripping Endothelial Keratoplasty / Q000379:methods; D004728:Endothelium, Corneal / Q000473:pathology*; D005500:Follow-Up Studies; D006801:Humans; D012189:Retrospective Studies; D020858:Tissue and Organ Harvesting
keywords: DMEK; Descemet membrane endothelial keratoplasty; Dissection; Lamellar keratoplasty; Liquid bubble; Preparation