A method to confirm correct orientation of descemet membrane during descemet membrane endothelial keratoplasty

Descemet membrane endothelial keratoplasty is a new technique for the replacement of diseased corneal endothelium with healthy donor endothelium. During this procedure, manipulation of the donor endothelium-Descemet membrane layer within the recipient anterior chamber can be associated with loss of the correct anterior-posterior orientation. Herein, we describe a simple method to keep the correct donor orientation during transplantation by marking the edge of the endothelium-Descemet membrane layer.

Interventional case series.

Donor discs were created by stripping of the endothelium-Descemet membrane layer from corneoscleral buttons. Before completion of stripping, 3 circular marks were set in an identifiable order at the edge of the donor disc. After removal of the recipient Descemet membrane, the donor graft was inserted into the anterior chamber, unfolded, and attached to the posterior corneal stroma with an air bubble. Correct anterior-posterior orientation of the graft was identified by the clockwise order of the 3 marks.

The marks allowed identification of the anterior-posterior orientation of the endothelium-Descemet membrane layer after unfolding in the anterior chamber and attachment to the recipient stroma in all cases. In 4 of 25 patients, orientation was upside down after unfolding of the roll, requiring inversion of the refolded donor graft.

Marking the edges of the endothelium-Descemet membrane layer helps to keep the correct orientation without adverse effects on donor detachment or corneal clarity during and after Descemet membrane endothelial keratoplasty.