Double-Bubble Technique in Descemet Membrane Endothelial Keratoplasty for Vitrectomized Eyes: A Case Series

To describe a modified technique for Descemet membrane endothelial keratoplasty (DMEK) in vitrectomized eyes that had undergone transscleral-sutured intraocular lens (IOL) implantation (IOL-suture) and pars plana vitrectomy.

This was a prospective interventional case series. Patients exhibiting endothelial dysfunction with aphakia, or dislocated IOLs, who underwent IOL-suture and pars plana vitrectomy, were enrolled. Patients underwent DMEK using the "double-bubble technique," which is characterized by the placement of 2 bubbles, 1 above and 1 beneath the graft. One small air bubble is placed over the graft for the purpose of unfolding the graft; the other large bubble is injected under the graft to enable fixation of the graft. Best spectacle-corrected visual acuity, central corneal thickness, endothelial cell density, the time of graft unfolding (using a surgical video), and the incidence of intraoperative/postoperative complications were analyzed.

This study included 6 eyes of 6 patients (3 men and 3 women; mean age 78.0 ± 2.5 years). Although the unfolding time was relatively long (10.1 ± 4.5 minutes), all surgeries were uneventful. Rebubbling was required in 1 eye (16.6%). Best spectacle-corrected visual acuity improved significantly in all eyes. There was no primary graft failure.

This technique (double bubble technique) enables safe and easy DMEK surgery, even in eyes that have been previously vitrectomized and IOL-sutured. Further clinical studies with a large number of patients exhibiting complex eyes are required to definitively establish the clinical value of this technique.