DMEK Surgical Disposable Set:
- Curved pipette for graft loading and anterior chamber insertion
- Dual luer-lock connector
- Straight glass pipette incl. Balloon for graft rinsing
- 5 ml. Syringe with luer-lock (2x)
- 1 x for graft insertion
- 1 x for BSS
- 1 ml. Syringe (air injection)
- 23G MVR knife (straight)
- 27G Blunt cannula (BSS)
- 30G Bent cannula for air injection
‘FOR ADVANCED DMEK SURGERY I FOCUS ON D.O.R.C. INSTRUMENTS’
Standardized ’’no touch’’ Descemet membrane endothelial keratoplasty (DMEK) 80% patients at ≥ 0.8 (≥20/25) at 6 months
- After its introduction one decade ago by the Netherlands Institute for Innovative Ocular Surgery (NIIOS) in Rotterdam, endothhelial keratoplasty has evolved toward selective replacement of the Descemet membrane, referred to as ’Descemet membrane endothelial keratoplasty’ (DMEK)
- Both the surgical steps for preparation of the donor tissue, ie harvesting the donor Descemet membrane, as well as the operative procedure, have been thoroughly standardized.
- To optimize the clinical outcome, and to avoid the risk of tissue damage and perioperative complications, the procedure can be performed as a completely ’no touch’ technique
- To enable surgeons to perform standardized ’no touch’ DMEK, a ’DMEK donor tissue preparation set’ and a ’DMEK surgical set’ were designed and developed in close collaboration with Dr. Gerrit Melles. Prepared donor Descemet – rolls can be ordered from Amnitrans Eyebank Rotterdam.
INSERTION OF THE DMEK GRAFT
A and B
After loading the graft, the glass injector is attached to a 5 ml. syringe.
C and D
The position of the double roll, which should be facing up inside the injector, is checked under the surgical microscope, and the injector is positioned into the main incision to insert the DMEK roll into the recipient anterior chamber.
E and F
After insertion, double roll should still be facing up. The endothelium is located at the outer surface of the DMEK graft.
CENTERING AND UNFOLDING OF THE DMEK GRAFT
A small air-bubble is positioned in between the ‘double-rolls’ of the DMEK-graft and by applying gently strokes with the cannula onto the outer corneal surface, the DMEK-graft is rotated.
The air bubble is enlarged to further unroll the DMEK-graft, and using the cannula at the outer corneal surface, the graft is centered.
Than the air bubble is enlarged to completely unfold the DMEK-graft, and to position it onto the iris.
D and E
After approximately ten seconds, the air bubble is aspirated and the cannula is positioned underneath the graft to inject air at the pupillary margin (air in between iris and graft).
E and F
Once completely unfolded, the anterior chamber is filled with air for approximately 45-60 minutes.