title: Techniques for Learning Descemet Membrane Endothelial Keratoplasty for Eyes of Asian Patients With Shallow Anterior Chamber.
abstract: OBJECTIVE
  To describe several essential surgical techniques that overcome difficulties in performing Descemet membrane endothelial keratoplasty (DMEK) for inexperienced surgeons, especially those who perform DMEK on eyes of Asian patients.
  
  
  METHODS
  Nine eyes of 9 Asian patients with bullous keratopathy who underwent DMEK were analyzed retrospectively. All patients were given a diuretic such as D-mannitol or acetazolamide shortly before surgery, with retrobulbar anesthesia and a Nadbath facial nerve block. Core vitrectomy before DMEK was performed in several cases in which a high vitreous pressure during surgery was predicted. The donor graft was stained with trypan blue, and a 25-G anterior chamber maintenance cannula was used to maintain the anterior chamber depth during graft insertion in all eyes.
  
  
  RESULTS
  The cornea became clear in all eyes. The best spectacle-corrected visual acuity had improved significantly 6 months after the surgery compared with preoperative values (P = 0.026). The corneal endothelial cell density was 1371 cells per square millimeter at postoperative 6 months.
  
  
  CONCLUSIONS
  Although DMEK is technically difficult, especially for inexperienced surgeons who operate on eyes of Asian patients, controlling anterior chamber pressure using various manipulations may help to prevent iatrogenic primary graft failure and lead to successful DMEK.
authors.affiliation: *Department of Ophthalmology, Yokohama Minami Kyosai Hospital, Kanagawa, Japan; †Department of Ophthalmology, Yokohama City University School of Medicine, Yokohama, Kanagawa, Japan; ‡Department of Ophthalmology, Heart Life Hospital, Okinawa, Japan; §Department of Ophthalmology, Ryukyu University, Okinawa, Japan; and ¶Department of Ophthalmology, Saitama Medical University, Saitama, Japan.
authors.forename: Takahiko
authors.initials: T
authors.lastname: Hayashi
authors.forename: Itaru
authors.initials: I
authors.lastname: Oyakawa
authors.forename: Naoko
authors.initials: N
authors.lastname: Kato
mesh_terms: D000086:Acetazolamide / Q000008:administration & dosage; D000368:Aged; D000772:Anesthesia, Local / Q000379:methods; D000867:Anterior Chamber / Q000473:pathology*; D044466:Asian People / Q000208:ethnology*; D003316:Corneal Diseases / Q000208:ethnology* / Q000601:surgery*; D057111:Descemet Stripping Endothelial Keratoplasty / Q000193:education / Q000379:methods*; D004234:Diuretics, Osmotic / Q000008:administration & dosage; D005260:Female; D006801:Humans; D007564:Japan / Q000453:epidemiology; D008297:Male; D008353:Mannitol / Q000008:administration & dosage; D009407:Nerve Block; D012189:Retrospective Studies; D014792:Visual Acuity / Q000502:physiology; D014822:Vitreous Body / Q000473:pathology
chemical_list: D004234:Diuretics, Osmotic; D008353:Mannitol; D000086:Acetazolamide