Customizing Illumination by the Operating Microscope Aids the Visualization of DMEK Grafts

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Abstract

Introduction

Our purpose is to present an alternative illumination technique in patients with clouded or opaque corneas, undergoing descemet membrane endothelial keratoplasty (DMEK).

Methods

Five cases undergoing DMEK surgery with poor visualization of the anterior chamber due to a clouded cornea or corneal opacities were included in the study. Three patients had bullous keratopathy and one patient had a previous corneal transplant failure. All patients underwent DMEK. During graft unfolding and centration, the intensity of the oblique field component of the operating microscope was dimmed by the help of a shutter knob and only coaxial illumination was used to enhance the red reflex. This illumination technique allowed visualization of the graft orientation and succesfull graft positioning was performed in all cases.

Results

Retroillumination by the coaxial microscope light was especially useful during observation of the correct orientation of the descemet membrane graft during the graft unfolding step of DMEK surgery.

Conclusion

In cases with more prominent corneal clouding or corneal opacities, retroillumination technique may be helpful in visualization of the anterior chamber and improve outcome of DMEK surgery by preventing the formation of an inverted graft.

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