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A Novel Microbubble Air Injection System for Controlled Graft Fixation in DMEK Surgery
Tsung-Ying Tsai1, Yu-Kai Kuo2, Shin-Yi Chen2
1Department of Ophthalmology, Taipei Municipal Wanfang Hospital, Taipei Medical University, Taipei, Taiwan.
Purpose:
To describe a novel, low-cost microbubble air injection system using a customized 3-French nasogastric tube for precise volume control and stable graft fixation during Descemet membrane endothelial keratoplasty (DMEK).
Design:
Retrospective, single-surgeon observational study.
Methods:
A total of 80 eyes of 80 patients who underwent DMEK surgery between 2021 and 2025 were included. All procedures were performed by a single corneal specialist with more than 15 years of corneal surgical experience and approximately 5 years of DMEK experience. The system consisted of a standard 27-gauge anterior-chamber cannula connected to a short segment of 3-French nasogastric tubing. Technical success was defined as generation and intracameral delivery of a microbubble sufficient to complete the intended graft-positioning/fixation maneuver without conversion to conventional syringe-based air injection. Device-related intraoperative complications, conversion, rebubbling, elevated intraocular pressure (IOP), primary graft failure, graft rejection, best-corrected visual acuity (BCVA), central corneal thickness (CCT), and postoperative endothelial cell density (ECD) were reviewed.
Results:
Mean age was 65.8 ± 12.3 years. Fuchs endothelial corneal dystrophy accounted for 49 eyes (61.3%); 60 eyes (75.0%) underwent triple DMEK. Technical success was achieved in 80/80 eyes, with no conversion to a conventional syringe and no documented device-related intraoperative complication. Mean BCVA improved from 1.05 ± 0.61 to 0.43 ± 0.42 logMAR and mean CCT decreased from 630 ± 86.3 to 533.9 ± 55.8 µm. At 1 year, postoperative ECD was 1609 ± 563 cells/mm2; estimated ECL was 35.6 ± 22.5%. Rebubbling was performed in 27 eyes (33.8%); elevated IOP occurred in 7 (8.8%), primary graft failure in 3 (3.8%), and graft rejection in 2 (2.5%).
Conclusion:
The novel microbubble air injection system is a feasible modification for DMEK surgery. Ergonomic customization based on the surgeon's hand size is critical for achieving optimal mechanical control, leading to successful graft fixation across diverse endothelial pathologies.
