Bagel sign and how to avoid it in DMEK surgery

Area of Science:

• Ophthalmology
• Surgical Techniques
• Corneal Transplantation

Background:

• Descemet Membrane Endothelial Keratoplasty (DMEK) is a corneal transplantation procedure.
• Ensuring proper graft adhesion is crucial for successful DMEK outcomes.
• Interface fluid can lead to graft detachment and post-operative complications.

Purpose of the Study:

• To describe a recommended surgical technique for gas injection during DMEK.
• To highlight intraoperative signs of interface fluid retention.
• To emphasize methods for preventing graft detachment.

Main Methods:

• A two-step gas injection technique using a 1 ml syringe is detailed.
• Initial slow, central gas injection smaller than the graft is performed.
• The gas bubble is enlarged after confirming no interface fluid (absence of the "bagel sign").

Main Results:

• The "bagel sign" serves as an indicator for interface fluid.
• This sign allows for correction of potential issues causing graft detachment.
• The described gas injection technique may prevent fluid retention and reduce detachment risk.

Conclusions:

• Identifying interface fluid retention using the "bagel sign" or iOCT is vital.
• Early detection of fluid can help prevent post-operative complications in DMEK.
• This technique enhances graft adhesion and improves surgical outcomes.