Safety-Net Suture for Aphakic Descemet Membrane Endothelial Keratoplasty

Area of Science:

• Ophthalmology
• Corneal Surgery
• Surgical Innovation

Background:

• Descemet membrane endothelial keratoplasty (DMEK) is a corneal transplantation technique.
• Aphakic eyes with large iris defects (unicameral eyes) present unique challenges for DMEK, increasing the risk of donor dislocation.

Purpose of the Study:

• To describe a novel, low-cost, and accessible surgical technique, the "safety-net suture," to mitigate the risk of posterior donor dislocation during DMEK in unicameral eyes.

Main Methods:

• A retrospective review of 3 cases of aphakic bullous keratopathy in unicameral eyes undergoing DMEK.
• Implementation of the safety-net suture technique: a continuous 10-0 polypropylene suture placed in a cat's-cradle pattern anterior to the trabecular meshwork to create a temporary anterior chamber barrier.
• Suture removal after air tamponade of the DMEK donor graft.

Main Results:

• Successful completion of DMEK in all 3 cases without intraoperative posterior donor dislocation.
• One case experienced partial postoperative graft detachment, successfully managed with repeat air tamponade.
• Corneal clarity maintained in early follow-up (1-10 months post-surgery).

Conclusions:

• The safety-net suture is a simple, cost-effective method for reducing the risk of intraoperative posterior donor dislocation in DMEK procedures on unicameral, aphakic eyes.
• This technique offers a valuable solution for complex cases, improving surgical safety and graft stability.