Graft-Repositioning Technique Using Infusion and Small Bubbles During Descemet’s Membrane Endothelial Keratoplasty

Background: Descemet's membrane endothelial keratoplasty (DMEK) is a highly effective procedure for corneal endothelial dysfunction; however, once a DMEK graft is deployed, repositioning can be challenging. Therefore, this study aimed to evaluate the efficacy of a technique that utilizes infusion and small air bubbles to reposition a misaligned deployed graft. Methods : This retrospective interventional case series enrolled patients who underwent DMEK between January 2022 and July 2023, including cases where the DMEK graft was attached and unfolded in off-center positions". Experienced surgeons performed DMEK by inserting an infusion cannula and positioning a small bubble in the anterior chamber after the graft unfolded off-center. The eye was tilted in a deviated direction, and the cornea was massaged from the corneal limbus to the center using a 27-gauge blunt needle. Before and after DMEK, we measured the best spectacle-corrected visual acuity (BSCVA), central corneal thickness (CCT), and endothelial cell density (ECD). Additionally, we monitored the incidence of postoperative complications. Results : Six eyes of six patients were included in this study. Postoperatively, the overall BSCVA and CCT of the eyes improved (P<0.001). However, one eye developed recurrent uveitis and required a sub-Tenon’s capsule triamcinolone acetonide injection. No eyes required re-bubbling, and no instances of primary graft failure were observed. Conclusion: The described technique enables the safe and feasible repositioning and unfolding of the DMEK graft.